The Wall

I hit the wall last night. We hadn't slept much the night before and it was a bit of emotional day anyway. It was Lauren's first birthday and we couldn't be together all day, but we got Nathan out for a few hours on a pass. The day itself after our normal morning changing of the guard was insane and exhausting. Read about that here at A Night in the Box. We had a nice little party for Lauren. We were all there and that is what is most important. A few other kids from the House and parents came. It was nice and quiet for the most part. Nathan wasn't feeling great. We had dinner as a family in the room. The kids just couldn't quite handle all of the emotions and it wasn't as fun or as good of a time as I wanted it to be. Nathan wouldn't pick something to eat. Julia cried at every little thing. Lauren hates dinner and was cranky. I'm glad we were together, but some of the being together wasn't much fun. That sounds terrible to say. But there it is. There were some high points in the day, but it seemed to last forever.

I brought Nathan back, dropped him in the room, and went and sat in the room that is called the "family center" but is something like a lounge for parents for awhile. I still wasn't very recharged, but settled in for the night exhausted.

I now have a new favorite nurse. Gabby is awesome. Amazing. Nathan's pump beeped exactly zero times during the night. She either programmed it right or was so on top of it that she came in to check on it before it beeped with each medicine she hung. It was fantastic. He woke me up to help him get to the bathroom. I noted that I had slept for a solid chunk of four hours and that was the longest chunk of sleep I had gotten in over a week. We settled back down and the next time I woke up was five hours later. I love Gabby. We have her again tonight.

Today was fine until it really sucked. We changed the guard just before Nathan's scan. My plan was to let Jules play for just a bit before heading back to the House. Her friend Sophia was there again and they had a great time in the play room. Lauren was happy for a long time too. I ended up letting them play. Then when Lauren got cranky I put her to sleep in the stroller and talked to Sophia's parents for awhile. They are a great family and I like them a lot. By then it was nearly time for Nathan's bone marrows to be taken and I knew that they would be done in the procedure room and I would get a chance to see him and Susan on the outpatient side, so I just kind of ended up sticking around. It is all good. Julia loves the play room and it is good for her. There isn't much for me at the House anyway.

If you read Nathan's journal, you will know that the preliminary scan results aren't good. Susan saw the scan and said it looked about the same to her. The onc agreed. We will get an official report next week. This is pretty terrible news really. He is number 1 patient on this study, so we couldn't expect great results, but it seemed like our best shot at a therapy that really could pack a punch. Nathan's body just hasn't handled it well and he has been down and in the hospital. Now we find out that after the first round had really good results that this second round may have not done much at all. It is quite a blow. I was feeling pretty down on the way back to the House and had another encounter with the bag lady at McDonald's (I know, Jill O, I gotta relax on the McDonald's workers, but it isn't really about them you see). Susan and really haven't talked things over too much yet. We will have some big decisions to make next week.

Nathan was in pretty good spirits this afternoon and evening. We will take him out on a pass again tomorrow and hopefully have a few good hours and dinner together again.

About the girl

I had a conversation sitting in the RMH dining room with a family therapist that volunteers his time to consult with the House and work with families. I asked a bit about how to best provide Julia with what she needs through this. Basically he said to provide as much love and patience as we can. Love I can manage. Patience is awfully tough.

Today was all about Julia in a lot of ways. Susan came to do the switch in the morning and as has become the routine, I took Julia and Lauren to the playroom at the outpatient side to hang out. The Child Life people and volunteers are great, there is a lot to do in the playroom, and Julia usually really enjoys the crafts and activities (today she decorated some kind of mirror thingy and made pizza). Usually I let them play awhile and then around lunch we head back to the Ronald for a bit to take care of things I may need to do there and to just get out of the hospital. Today Julia was playing with one of her friends that she made at the Ronald, a lovely little six year old whose brother was in for the day getting blood transfusions. They had a good time and Lauren was having fun too so I just hung out all day without leaving the hospital and switched with Susan in the afternoon. It wasn't too bad and I hope it was good for Julia. She seemed to be having fun.

I'm annoyed with some things about the hospital stay, which is inevitable. We have been here since last Tuesday and we are still having different nurses and nurse assistants. I'm sick of explaining everything to them about the details of Nathan's current routine. This includes how we like to give him his medicine, what pre-meds he needs for transfusions, and that his damn blood pressure is all over the map. Today's staff seems so surprised that his blood pressure is high. They are like, "Wow!". And I keep saying, "I know it is high, but if you look over his chart you will see that there is no reason to be surprised by it. Especially since he had a transfusion today". I'm done explaining Nathan's care to the staff. If they just bring me the meds and teach me how to operate the pump and then left us alone all day I would be happy. And, for the record, we have some really great nurses and assistants (especially one assistant that works nights named Ron who really makes us feel looked after). I'm just tired of having different ones. The concept of assigning a primary nurse is really a great idea. I just wish that it was followed through a little better in the places I've been that claim to do it.

Currently it seems like they have Nathan's scan schedule all screwed up. It was squared away, but we had to cancel all of his outpatient scans and then they had to reschedule them all since he is inpatient. Same scans. Same facility. The only difference is apparently the "outpatient" versus "inpatient" designation and the need for patient escort services for the inpatient scans. There are probably different billing codes or something for insurance. Horrible inefficiency and as of right now it seems like they have him scheduled for his nuclear medicine scan prior to receiving his radioactive isotope injection. Hospitals need to fix this type of thing. It is bad business process.

Nathan, after several nights of going to bed early, wouldn't go to sleep tonight. As I've been writing this entry he has been telling me about how Darth Vader really is Luke's father (he just watched Revenge of the Sith) and explaining to me the many variations of diarrhea. You know how they say Eskimos have so many words for snow? Well, Nathan has apparently worked out verbose descriptions for about as many forms of diarrhea. Now he just needs to make up words for them. He also just informed me that he figured out "what makes 16". The answer is 4 + 4 + 4+ 4. I asked him if he had done that math with his teacher today and he said no, that he had just done it in his mind.

I think I'm doing okay today. I'm in soldier on and focus first on the needs of the kids mode. My patience is okay. I wouldn't say I was in good spirits or bad spirits. I would say I was just feeling a bit numb and resigned. Oh yeah, and very, very tired.

Thoughts of home

I was hit with a serious bout of homesickness last night. I've been homesick in the important sense of wanting to be at home in a normal environment for my family. Last night I couldn't help but think about and actively miss specific physical comforts of home. There are obvious ones like the classic "my own bed", but I was thinking about a lot of other things too. In one of those near dream experiences when you are hovering between awake and asleep I took a virtual walk through our house in my mind. I felt that I missed even something as basic as the layout and floorplan of the house. I felt really homesick as I walked past my guitar hanging on the living room wall. As I walked through the family room I thought about the shows on our Tivo that have probably starting rolling over so we won't have the episodes from where we left off watching. In the kids room I felt really sad as I saw Julia's Raggedy Ann blanket lying on the floor. When she and I are home alone we snuggle/cuddle on that blanket on the floor before she goes to bed. The blanket has a little pouch where it can all be folded up into a pillow. Each night before bed she was putting Soccery (a pink and white Nike soccer ball given to her by the wonderful friend Ouida) to bed in that pouch after we cuddled. I could go on. I'm sure the comforts of home are intertwined with the emotional aspects, as clearly evident in missing a child's Raggedy Ann blanket, but I haven't ever really experienced such a strong recollection and emotional response to the physical things from home.

Susan has been here without a trip back a lot longer than I have. So has Nathan obviously. I can't imagine longer emotionally difficult separations like military deployment. I don't mean to be whiny. I know it could be worse. But bad is bad enough for me.

Roller Coaster

Last night I resolved to begin posting near daily entries here. If ever there was a time to give a real effort to this experiment that is "Cancer Dad", that time is now.

Yesterday and the day before were really tough. With Nathan in the hospital and Susan needing to nurse Lauren before bed and when she gets up, I have nightly hospital duty. Susan and I see each other in passing as we swap sitting with Nathan and hanging with Julia and Lauren. Despite really bad sleep, I'm holding up pretty well with the hospital in general. The first two nights Nathan was up coughing all night and we didn't sleep. Since then he has slept, but is up at least three times a night to use the bathroom. We can also count on a handful of nurse interruptions. Yesterday and the day before things were really getting hard on everyone. Lauren was hating not seeing her mommy during the day. Julia was acting out. Things are so hard on her. She can't see her brother. She gets shuttled back and forth between the Ronald and the hospital. She has zero control over her actions and time. And I'm sure she feels like a second class member of the family with the attention Nathan gets and the attention Lauren, as a baby, demands. So, the weight of this hospital stay was definitely getting to us.

Today I felt differently. Nathan had two good days where he was playful and good natured. Yesterday Susan seemed to have a nice day at the zoo with the girls. Today I had a really good day at the Ronald. We had a nice brunch, Julia got to do crafts, Lauren napped so I could easily shower, and I had some really nice talks with families in the house that I really enjoy. After Susan and I switched roles for the night, Nathan and I watched some of a NASCAR race and he was tired but really trying to stay up to watch some of tonight's football game with me. He is rooting for the Giants because he loves New York so much. I'm, of course, rooting for the Bears (who are off to a bad start on their first defensive set of the game as I type this) and he was having fun about cheering on the other team.

Things turned when he had to get his nightly shot and was getting tired. He was so sad. He kept saying, "Why do my counts have to get better before I can leave" and "I hate my stupid fever" and "I hate stupid counts". Then he drove it all home with, "I'm so sad. I just want to go home". I don't think he meant back to the Ronald either. We are really struggling with how to keep fighting and keep his and our quality of life as good as it can be. This trial was so promising, but we didn't expect to be away from home this long or for him to be in the hospital for any prolonged period of time. It really, really sucks for all of us, but especially for Nathan. Poor beat up guy just wants to go home. I promised him that when it was safe for him to travel that I would take him home. I hope I can deliver on that one.

I cuddled with him while he sobbed. Then a show came on recapping today's football games and I told him who each team that was playing was and where the cities were. He would pick who he wanted to win and then when the recap was done we would see if his team won. He perked up and was having fun watching the show and hiding under the covers. He wanted to stay up for tonight's game but he crashed and fell asleep just a bit before kickoff. At least he was in better spirits.

I really want to be able to take my family home. All five of us are riding different emotional roller coasters right now. It takes a huge toll on us all and it is hard being at different places on the ride at different times (although I suppose it is good that we aren't all at or lowest lows at all the same time usually).

Protocol 06-072

This is the protocol Nathan is currently on.

200s

You may not be at all interested in this, but I find it quite fascinating. They are measuring Nathan's "output" here in the hospital. So he pees in a "hat" in the toilet. I have helped him get his IV pole into the bathroom several times while he has been here and each time he has peed in almost exact 200 cc volumes (on the hat 200 cc is about 6 oz). Typically he outputs 200 ccs. I can count on a 400 sometime during the night. I wouldn't have guessed hat a 45lb six year old boy would be able to hold a whole can of soda's worth of urine in his bladder.

Any medical reason for the consistency and the 200 cc increments?

Control

Nathan has been in the hospital for several days. Over the last couple of days he has felt pretty well, but is just here isolated to his room. He can't do much and way too many things that he has to do (take medicine, get a daily shot, etc, etc) are dictated by others. He is definitely feeling the loss of control and beginning to rebel against it by attempting to assert control. Quite unfortunately, and probably none too surprisingly, he has chosen two things that he can have no control over to attempt to refuse. He tries to refuse receiving his nightly shot. He is here in the hospital because he got a fever while his immune system is compromised. The shot helps boost white blood cell production. We can't skip that. (Susan and I have a few control issues over this one as well since when at home we can do this via IV but here they insist on doing it via shots). The shots are actually no big deal. He has received them hundreds of times probably over the last three years and they don't really hurt him much at all. He just doesn't want them.

The other thing has has begun to try and refuse is to wash his hands after he uses the restroom. We really can't have that. This morning we stood in his bathroom for about five minutes with him saying, "I am *not* going to wash my hands". Finally he gave in. I hope our stays in the bathroom don't get any longer. I had the nurse explain the importance of hygiene this morning. Sometimes he listens better to others than he does to me.

A different language

I got in the elevator here at Ronald McDonald House NYC and saw a woman I recognized from around the house but had never really chatted with. I casually said, "Hi. How are you?". She smiled and said, "We're going home today". No need to say more.

Ball o' nerves

I've been neglecting Cancer Dad. That means, I think, to some degree that I've been neglecting my need to deal with this well. I've written a couple of posts that I threw out. It was good for me to write them, but nothing to share. Maybe I'll post one of them someday. Probably not.

Today I am sick. Scans. I have told others and myself that I'm not too worried about these. That it would seem unlikely that the cancer would have grown through this first round of the new treatment. That I don't expect them to be better, but that I don't expect them to be worse either.

And I don't. I don't expect them to be worse. But I am afraid that they will be. Very afraid.

Long distance?

Sometimes it seems like a burden to have to travel all the way to NYC for Nathan's treatment. In the last two days I have met kids in the Ronald McDonald House from London, South Africa, and Greece. At an event for parents tonight I met two women from different Caribbean islands.

There are a lot of reasons to be happy to live in America. Top quality medical care is one of them. Sometimes it boggles my mind that the quality of care and treatment options can vary so much from facility to facility and city to city. It is when I'm here that I am thankful that at least I can get world class care in my country.

Blue Manhattan

In NYC. It is good that we are all here as a family. It is bad that we all have to be here. So much of all of this has a "flip side". Susan is out with the kids. I'm putting in some hours working from the RMH. Don't have much time or ability to organize my thoughts for a good post. So, I leave you with a post that might be more like you would find at A Night in the Box.

Ryan Adams - My blue Manhattan

She's angry like a child but how sweet
Fire and rain on the street
It's you against me most days
It's me against you doll
Ah, the snow's coming down
On the cars in midtown
Stone cold in sheets
With you all over me
Ain't that sweet my little gal
Ain't that sweet my little gal

My blue Manhattan
She cusses with her sailor's mouth
And fire and rain on the streets
It's you against me most days
It's me against you doll
Making snow angels
In the gravel and the dirt
Crawling like a spider
And I'm somewhere inside her
Too hurt to move
Too hurt to move

Deja Vu - Julia knows too much

Back in June I posted about Julia's concerns for Nathan. When she and I were driving home after dropping the rest of the family at the airport to head to NY to get the scans that would ultimately show his current "relapse", she dropped the "Sometimes kids die" bomb seemingly out of the blue. As noted in that post, when I asked her why she was thinking about that, she totally punted and said she "didn't know".

Well, as we were driving back from Denver yesterday after having dropped off the rest of the family to head to NY for Nathan's treatment, Julia says to me, "Sometimes kids die". Again I asked her why she was thinking about that. She gave me some story about cars sometimes hitting trees and hurting people. It is so hard to know how deep to go with the kids about serious issues. I tend to take their lead and go as far as they want/need to go. I think it is pretty clear that she is piecing it all together, but that she doesn't quite want to take the train of thought/conversation to its logical conclusion.

She has shown some other signs that could be coincidence, but may not be, along these lines. Apparently when we were away on our last trip she talked a lot about missing Lauren, but little or none about Nathan. Earlier this week she was listing members of our family and omitted Nathan (This one could easily be a coincidence. She doesn't always keep lists and things like that organized in her mind.).

I suppose it goes without saying that I have a lot of fear and concern about Julia. I worry about how our family's focus on Nathan impacts her emotionally and I worry about how it will impact her if we lose Nathan. So we just keep doing the best we can and will continue to do so. Sometimes our best isn't good enough. Trust me on that one. Sometimes our best isn't good enough.

Phase I

The last couple of days have been hectic. Susan, Nathan, and Lauren were off to NYC this morning after getting the go ahead to come yesterday. While it was had getting everything ready and the upcoming week+ is likely going to be hard on everyone, especially Susan, Nathan, and Lauren, it is really a good thing to be getting started on something.

The treatment Nathan is starting next week in NY is a Phase I clinical trial. The drugs being used have been given in clinical trials before, but not together. I haven't found any description or information of the trial online.

From documentation on the FDA's web site.

Phase I Clinical Trials

The purpose of a Phase I clinical trial is to find the best way to give a new treatment and how much of it can be given safely. In a Phase I study a new treatment is given to a small number of patients. For a new drug, the study starts by giving a very low dose of the drug, then the dose is slowly increased as new patients enter the trial. The dose can be increased by giving more at one time or by giving the same dose more often. Physicians watch patients carefully for any harmful side effects. Although the research treatment has been well tested in laboratory and animal studies, the side effects in patients cannot be completely known ahead of time. Phase I study effects may involve significant risks for this reason. They are offered only to patients whose cancer cannot be helped by other known treatments. Phase I treatments may or may not produce anti-cancer effects, but some patients have been helped by these treatments. Once the best dose is chosen, the drug is studied for its ability to shrink tumors in Phase II trials.

So, what is this "neuroblastoma" thing anyway?

My Google News RSS feed on neuroblastoma picked up a pretty quick but informative read on the basics of neuroblastoma. The piece comes from Metro West Daily News, which appears to be a section of the Boston Herald, and is in the format of a doctor's response to a reader's question. It seems a pretty well-written summary of NB, with little information that I disagree with or take exception to (after you've done this NB parent thing for awhile, you even start to disagree with doctors and common assertions about the disease based on your own experience and those of others you know).

So, you can refresh your neuroblastoma knowledge with this primer from Dr. Jeff Hersh.

Adjusting

If you would have asked me who would have the most difficult time adjusting to being back at home as a family, just knowing our various personalities and coping mechanisms, I would have said Julia and Susan in that order. As it turns out, I think the reality was (1) Nathan and (2) Luke. Julia was great all weekend. Sure, she had a few meltdowns but overall she was fun, well-behaved, and just a real joy to be around. Nathan, on the other hand, was an obnoxious little brat most of the weekend. He was selfish, disobedient, openly defiant, and very, very whiny. I think I did okay on Saturday, the day of our return, at being patient and calm with everyone. Yesterday I was feeling fine and pretty well adjusted through church. Susan was a bit worried about a day at home with the kids, but I was looking forward to that so she ran out to take care of errands that had built up while we were gone and I settled in with the kids. By 4:00 in the afternoon I was pretty much done being a parent. I asked Susan to switch from our usual seats at the dinner table because I really didn't even want to sit by Nathan. It seemed like all I did all day up until the afternoon was patiently do things for Nathan and it was never enough.

Things have been hard on all of us. Jules has been beautiful, but I'm sure there is an explosion of emotion waiting just under the surface for her too. Nathan, I think, had a hard time adjusting to not being the center of everything like he is in New York. I was tired and Nathan kept dashing my hopes of a fun family day by acting out his emotional distress.

Even though it doesn't sound like it, I'm happy to be at home with everyone and had some really nice times this weekend. It has been hard for me to just jump back into it all though.

I wonder who will have the shortest fuse tonight? The kids after a normal weekday school schedule? Or me after banging my head against the wall trying to focus on work? Oh wait, I get to escape right after work to run off some of my anxiety on the basketball court. I sure hope the evening goes okay for Susan, but I'm sure glad I'm escaping the house and everyone in it for a bit.

If you are angry

Well, there are a lot more interesting comments being dropped in Nathan's CaringBridge guestbook. People are angry and outraged, and that is fine and reasonable. I know I have much less readership than Nathan's journal, but I'm not so comfortable addressing this issue there. I guess I feel like in some ways being angry for us is one way for people to cope, and I don't necessarily want to take that away from them.

Areas people are upset about are the (A) waiting/disorganization/perceived lack of compassion from the hospital staff in a couple of instances this week, (B) the lack of answers available to our questions about possible effectiveness and side effects of the new treatment we want to get Nathan on, and (C) the fact that we have to wait to begin treatment until the drug company and hospital can dot all of the Is and cross all of the Ts.

(A) Yes the doctors here at MSKCC don't always communicate the best. Yes sometimes you wait forever and can get lost in the shuffle of things. Yes, I think they could improve. This is not something I'm up in arms about. The flip side is that the doctors and staff are very caring. They may not provide the caring familial feeling we get in our small clinic at home, but they do care about Nathan. Even though he isn't there often, they always remember him and his interests and make him feel good. He has great bonds with some of the nursing staff and the volunteers and Child Life people in the playroom are great. It is sometimes a little mind boggling that what I feel is *the* world-class facility in terms of neuroblastoma treatment can be at times so disorganized. I think one of the root causes though is that they squeeze themselves so much to see as many kids that require intensive therapy and care as they do. How can I argue about that. They see as much volume as they can and then some and they strive everyday to conquer neuroblastoma. To some extend they are jaded and a little harsh, but I'm not going to hold it against them. Yes there are different types of trials and other facilities with NB teams and it is quite possible that the final and best breakthroughs will come from somewhere else. I'm not someone that thinks if you don't take your NB kid to MSKCC you are doing your kid and family a disservice, but I'm glad to be here and think that continuity in care and comfort with a facility is important to Nathan and our family at this point. There may be problems, but I'm an MSKCC fan. I'll take him somewhere else when I think we need a lighter and less aggressive approach for Nathan or when we run out of things at MSKCC, but not before.

(B) When Susan talked about not getting answers from the doctor and getting an "I don't know" response, she was talking about specific questions about side effects and expected response. We could have gotten much better and more voluntary answers about timing, logistics, travel requirements, and etc, but the doctor really didn't know the answers to the questions. Nathan will be the first human patient to receive this combination of drugs. They really don't know if he will have side effects that could keep him out of school. They really don't know and don't feel it is appropriate to conjecture what type of response is possible. They think this is possibly a good therapy, or they wouldn't be investigating and that is about all we can know or hope for. We are out of the world of any type of protocol with any type of track record. They think this might ease Nathan's disease burden and give him time, but there is no prognosis at this point. There is no cure. If you are angry at "I don't know", which you should be and have every right to be, don't direct it at this protocol or this doctor. We are talking about a disease where when diagnosed at advanced stages, which a high percentage of children like Nathan are, sees roughly 40% of those Stage IV kids make it five years. Every current protocol that is not a clinical trial is the protocol developed by a trial that just closed. Kids diagnosed now get different treatment and supporting drugs than Nathan did when he started three years ago. The doctors don't know what causes the disease or how to effectively attack it. Kids are stuck for the most part with trickle down therapies that have been effective in adult cancers. But any doctor worth anything will tell you that kids aren't little adults. Their cancers are different and if there is something to be sad and angry about it is that so few hospitals and organizations are out there specifically trying to find new therapies targeted at kids. So, if you are angry/outraged/shocked by Nathan's story, support organizations that solely focus on finding new therapies for childhood cancers.

(C) This is just crazy. I know that there are real economic issues involved and that from a business standpoint the hospital and drug company must come to legal terms for release of this drug for use in this clinical trial, but to have to wait on legal negotiation (which is what I assume we are waiting on based on comments from the doctor) is terrible. This is a flaw in the system and I could probably ramble on for pages and pages about what I think the root cause is, but it isn' t worth any more time than I already can't help but stress about it. It is out of our hands and I have enough to be angry about without getting even more worked up over this.

A new attitude

There are some really interesting mixed reactions to our latest news. This can be seen at Nathan's guestbook. Essentially, there is no change in Nathan's disease since the relapse was found in June. Since then he has had two rounds of chemo, one of which we knew probably wasn't effective. I find the reactions pretty interesting. On one hand, I think there are some people that are probably "just getting it". This is really the first example of treatment that didn't knock the disease back. Also, I think perhaps writing that the doctor seriously told us that doing nothing was an option was a bit of a reality hit for some people. My emotions are clearly conflicted on this. It hit me a bit hard in the moment of hearing that the disease was basically the same, even though going in we knew that the point of the big shot of chemo we did was to keep the disease from progressing so that we had at least some treatment options available. So, was the news bad or good? I think for the people that haven't quite realized or let themselves believe that this disease will take Nathan's life, it was pretty bad. In the sense that we do have at least a couple of options on the table because he hadn't progressed, it was good. By any reasonable standard though, I suppose the news was bad. The cancer is there and it is "impressive". That just equals bad. It always will. It can be nothing but bad. I'm trying to have a new and improved attitude though. I think I'll feel better when we know for sure what the schedule to start a new treatment will be. Unfortunately that depends on some red tape around a clinical trial. Once it is all solid, I'll try on my new attitude. That is the one where I'm grateful to be able to do something that may prolong our time with Nathan.

The constant struggle

Today, like many days, I can't help but ponder one of the toughest things about all of this for me. I think there is a bit of a paradox buried here, and like any paradox it is a bit difficult to wrap my head around. I have always said that the most important things to me were my relationships with family and friends. I'm pretty sure I always meant and felt that, but I clearly feel that so much more strongly now. These relationships and the very lives of the people that I have them with can be fleeting. That is just one of those very harsh realities of life. So I am acutely aware of how important people and my relationships are to me, but the area of my life that seems to be impacted the most adversely is exactly my relationships with those closest to me.

Every day everyone has to work at these things. Working on them with the weight of the stress, sadness, and grief over the loss of how I expected my life as a husband and father to be is very difficult.

Wouldn't you?

So, if you left a voicemail with your HR rep explaining that you were going to be exhausting your leave to take care of a sick child and that you needed to know what your options were regarding a) going negative in annual leave or b) requesting leave without pay under family leave, wouldn't you expect to hear back pretty quickly?

Now, I'm being really impatient here. I left the voicemail early afternoonish yesterday, which is late afternoon where this HR rep is located. But, that also means it is late morning her time now and I haven't heard a peep back. Seriously, I would at least expect an, "I don't have any answers yet but I'm looking into this and will be back to you as soon as I can?". And given the nature of the request, I would expect that to come quickly.

Really though, I suppose it is only the matter of a few working hours. Perhaps I've become a slave to our instant communication age.

I'm just cranky about other shit this morning and taking it out on my HR rep. But hey, if you can't beat up on your HR rep when you are having a shitty morning...

Back to School

My boy is going to school tomorrow. "All day" school. First grade. They have been in session for a couple of weeks. Nathan's immune system hasn't been up to snuff for being out of the house much, let alone sharing a small space with a bunch of snot-nosed kids. He has been getting tutored at home, but we want more than the learning for him. We want him to experience school and make friends. He has a window of a couple of days that he can go while his counts are up and before we head to New York for tests and maybe more treatment. There is a really high likelihood that the next treatment he gets will knock his immune system down again for awhile where he can't be in school, so I'm really happy that he gets to go to school tomorrow. Really. I feel happy about it. It is nice to feel good, even if it is only for a brief moment.

As I closed the door of their bedroom tonight after going in to tell them to stop talking to each other and go to sleep, I heard Nathan say quietly, "Julia, I'm going to have fun tomorrow". And yes, I'm teary-eyed as I type that.

My boy is going to have fun tomorrow.

Distraction

I'm struggling this morning. I'm trying so desperately hard to focus on work I'm behind on and in serious crunch time with. My mind keeps wandering. Today I can't help wonder if I'm doing enough for Nathan. Am I providing him with the life he deserves in the likely short life he will lead? That is the question running through my head, eroding my peace of mind and leaving me feeling more selfish than anything. You see, I don't think I'm worried about Nathan as much as I am for myself on this one. What difference does Nathan know? No, what I really scared of is that when he is gone that I won't be able to be satisfied that I did enough or provided enough for him.

I haven't posted much here lately. Probably because I've been spending a lot of time feeling sad, selfish, angry, lost...exactly all of the things I initially created this blog to vent about.

Mark my words...

For obvious reasons I'm a big fan of any organization that focuses on awareness of and finding cures for pediatric cancers. Coaches Curing Kids' Cancer combines these noble efforts with sports, another thing I'm a big fan of.

For those ESPN College GameDay fans, former college football coach and current analyst Lee Corso was just named the organizations National Spokesman. Good for Corso. Good for the organization to have such a recongnizable (thing about the people involved in it and their target) spokesman.

I've seen glimpses into corporate press release writing and seen "quotes" sent to the person they would be attributed to for review before incorporation into a press release. This was obviously done with Corso for this release, and the author of the quote got Corso's signature "Mark my words..." into it. Nice touch.

“What a win-win,”’ said Corso. “Teams get to say thank you to their coaches while the money goes to new pediatric cancer treatments. Mark my words – Coaches Curing Kids’ Cancer is going to be huge.”

Link.

Bad news for the cancer dads

Psychological Distress and the Impact of Social Support on Fathers and Mothers of Pediatric Cancer Patients: Long-Term Prospective Results -- Wijnberg-Williams et al. 31 (8): 785 -- Journal of Pediatric Psychology

I've just read the abstract. I'll have to get one of my many doctor friends (or librarian sister) to dig up an electronic copy of the paper.

Conclusions Dissatisfaction with support and negative interactions that fathers experienced significantly affected their levels of psychological distress. No such effect was found for mothers.

I wonder if it delves at all into what coping mechanisms, or lack thereof, that causes fathers, in general, to have more impacted levels of psychological distress in the long term than mothers. Perhaps that is for a future study.

As if I needed another reason to love the 1985 Bears

This is from today's Chicago Tribune.

Jim McMahon and many other members of the Bears' 1985 Super Bowl champions will convene in Lake Geneva, Wis., this weekend to participate in a charity golf event to raise money for the Neuroblastoma Kids Foundation.

200,000

Nathan's CaringBridge site went over 200,000 visits sometime in the last couple of days. That blows my mind. Susan created the site 1,213[1] days ago. I know the traffic ebbs and flows depending on Nathan's status (I think we have been getting somewhere around 300 visits a day over this last week of chemo), but just for fun on average we have seen roughly 166 visits per day over a period of 3 years and 4 months.

Wow. Thanks for caring.

[1] I think it is fun that the quickest and simplest way for me to calculate the number of days was to query Oracle with
select sysdate - to_date('2003-04-13', 'yyyy-mm-dd') from dual ;

Vomit and Neuro-Toxicity

I had planned a fairly light post about the casualness that a cancer kid and a cancer dad talk about things like vomit. That was when the day was going well and Nathan was playing on his hospital bed, laughing, and trying to eat something after just having thrown-up for the second or third time of the day. All was good (a cancer family has a different scale than most). I think I'll still go ahead with the lighter side. I wrote a fair amount about the other stuff on Nathan's journal. I don't really care to write about it again, but if you want the complete picture of the day, you should read the account over there too. Neuro-toxicity sucks.

Anyway...here is a fairly typical dad/son conversation during a round of chemo.

Setting: Mexican restaurant drivethrough. I've just been handed a bag with breakfast burrittos and am waiting for the person to run my credit card. Nathan throws up in one of the ever-present pink "throw up bins".

Nathan: Daddy. I threw up.
Me: Okay. I'll dump it after I pay and we can get out of the drive through. You still want your burritto?
Nathan: Yes.

Nathan opens the potato and bacon burrito to go at it with a fork.

Nathan: It has bacon! Its soft! I like the bacon. Are these mashed potatos or breakfast potatos?
Me: Breakfast potatos.
Nathan: Did I throw up once or twice last night?
Me: I think just once.
Nathan: It looked like ground beef and melted cheese.
Me: Yes. It did.

And with that, conversation dwindled off a bit as dad and son enjoyed their breakfast burrittos in the car on the way to the hospital for another day of chemo.

Words

Here are a few words that have popped up frequently in conversations I've had lately. In some cases the context has been Nathan's disease and the pressures it puts on our family, in others the context has been music or other "normal" topics. I just find it somewhat interesting that they keep popping up. "bleak" and "forlorn" are words that have been used to describe music that I have recommended to people. I haven't been purposefully seeking bleak and forlorn music, but I must be drawn to in that direction in general.

bleak
1 : exposed and barren and often windswept
2 : COLD, RAW bleak November evening
3 : lacking in warmth, life, or kindliness : GRIM b : not hopeful or encouraging : DEPRESSING bleak outlook c : severely simple or austere

forlorn
1 : BEREFT, FORSAKEN forlorn of hope b : sad and lonely because of isolation or desertion : DESOLATE forlorn landscape
2 : being in poor condition : MISERABLE, WRETCHED forlorn tumbledown buildings
3 : nearly hopeless forlorn attempt

hope
intransitive verb
1 : to cherish a desire with anticipation hopes for a promotion
2 archaic : TRUST
transitive verb
1 : to desire with expectation of obtainment
2 : to expect with confidence : TRUST

fair
I couldn't quickly find a good definition of "fair" in the context it is used, which is often, "It isn't fair that you have to go through this". The closest thing I quickly found is in the synonym "just".
2 a (1) : acting or being in conformity with what is morally upright or good : RIGHTEOUS (2) : being what is merited : DESERVED just punishment b : legally correct : LAWFUL just title to an estate

Fair/just is an interesting one. Buried in the various definitions of fair and just is this concept of conformity with what is merited, or deserved. There are some things that no one could deserve. If something can't be deserved, then fairness is a concept that cannot be applied. No child deserves to be sick. No parent deserves to watch their child fight for his or her life or to be forced to make decisions based on weighing length versus quality of life. These things aren't fair because the concept of fairness cannot be applied to them. They aren't unfair either. They can't be.

Being a parent is an awesome and terrible responsibility. Dealing with this disease is not what I expected, but it is what I signed up for.

All definitions taken from www.webster.com.

Borrowing from Bob

Things have been a bit slow here, and over at ANitB. It isn't so much that I don't have a lot to say or a lot on my mind, it is more that I either have too much swirling around to nail down something interesting or helpful to me to write, or I'm avoiding things when I can. I think over the last couple of weeks I've been using music as an outlet. I'm trying to learn to play it, and I'm listening to some new and interesting things. Today I have a particular verse of a Bob Dylan song stuck in my head. I've known the song for ages, but have been reintroduced to Buckets of Rain by Jeffrey Foucault and his collaboration with Redbird.

Life is sad
Life is a bust
All ya can do is do what you must.
You do what you must do and ya do it well,
I'll do it for you, honey baby,
Can't you tell?

Listen to Redbird's version here (5.05 MB via RapidShare).

Uncertainty

Not knowing is not good. Or maybe it isn't. Maybe not knowing is okay if what you don't know is bad. What I don't know right now is if the one round of chemo Nathan has had since this bone marrow relapse has done any damn good. What I won't know for awhile is if the second round he will hopefully start next week (Send good thoughts on this. Timing is important when hitting this with multiple rounds of chemo.) will do any good. I don't know what is next in terms of treatment, therapy, travel, etc. I don't know a lot of things related to this and all of those unknowns scare the shit out of me or worse. Not knowing sucks. Or maybe it doesn't. I guess I just don't know.

It's all relative

I'm sick. I feel pretty low. Nathan is sick too. And his counts have been bottomed out for awhile. Makes it hard for me to complain too much. I can't even imagine how nasty he has been feeling.

The Importance of Family

My parents are coming for a visit. We were trying so hard to visit them, but then everyone's health here started to "go South". I'm really looking forward to having them here. "Looking forward to" isn't quite right. I think some of that good parent love will be good for me. Once we started our family I gained a new appreciation for my parents. I think that is natural. You begin to understand what the love they feel for you must be like as you experience a similar (I don't believe any love can be the same) love for your own children. I get an even stronger sense of that now. I struggle constantly with watching Nathan fight, mostly unknowingly, for his very life and the fear and pain that it causes me. I feel so hopeless so much of the time. I know my parents feel the same way as they fear not only for the life of a grandchild, but also feel helpless while watching their own child suffer. They sure have had a rough road through this battle too. They do make a difference, even though they may not feel that way at times.

Fever Watch

We are all pretty tired around here. We have had the obvious stresses of illness, hospital stays, restless sleep, and etc. It seems we may all be sharing a bit of a bug now too. Lauren's nose is running and she was crankier than usual. Susan was dozing by 8pm and out for the night as soon as Lauren went down. I'm beat at 10:30pm as I write this. I just checked Nathan's temperature though and it was higher than I'm comfortable with. His docs are being really good about trying to keep him out of the hospital. If we can get his fever down with antibiotics and fever reducers (tylenol) then they want to keep him at home. His fever just shot up pretty good though. It was time for the tylenol, but I'm not comfortable going to bed until I know it has gone down. I'll check him again at 11:30pm and then hopefully it will be low enough to crash until our alarm goes off at 3am to check him and give him more tylenol. This sucks, but it is better than having him in the hospital if we can get it back in control until his counts go up.

Honesty about "the end"

Susan pointed this out to me and it popped on my Google News feed about neuroblastoma as well. If you look hard enough you can find a lot of stories/biographies about kids with neuroblastoma and other cancers. There are lots of smaller town papers that carry features about the kids and families that are sick in their community. You can read blogs or journals that families keep about treatment. Rarely will you find a lot of detail shared about a child's final days. Occasionally you run across a journal that lays it all out there. There is a story prominently located on The Arizona Daily Star's online service about the final days of a young boy's brave and brutal battle with neuroblastoma. This article isn't an easy read, especially if you are close to Nathan or any other child fighting this battle. It is very brave of this family to share this part of their son's story. I can't imagine a more private time and event, but it is important, I think, for people to understand the pain and brutality that cancer wreaks on these amazing and beautiful children. This family was very brave to have shared. We should honor their bravery by reading and sharing their story.

Entitled? You Betcha!

Tough couple of weeks. First was the relapse news. Then was the go/no go decision for taking a vacation. Then there were the fevers and hospital stay after making the "go" decision. Then there was Julia with pneumonia on oxygen at home while Nathan was in the hospital. Susan and I are completely drained. On top of the logistics and the physical just doing things that have to be done, the weight of the stress and the fear and the worrying is completely draining and exhausting. You know that "knot" in the pit of your stomach that you sometimes hear about? I didn't know that it was a real physical thing you could feel. It is and it is something that I'm just living with for the time being.

Anyway...on to the entitlement story. Thursday morning (after getting Nathan settled into the hospital in the middle of the night and getting about 2 hours of sleep) Susan called saying that Julia was feeling very bad (she had been battling a cough and intermittent fevers for about 10 days) saying that her babysitter took her pulse oxygen level and that it was really low. She already had a doctor's appointment scheduled that we were going to cancel, but decided we needed to keep. Leaving the hospital and going straight to get Julia and then straight to the doctor would get me to the appointment late. I wanted to change clothes at least (I was wearing the sweat pants and t-shirt that I had worn to the hospital and "slept" in), but I figured I would try to keep as close to the appointment as I could. On the way I decided to call and warn the office I would be late so they didn't think that we had just not shown up. I had a conversation with the scheduling lady that went something like this:

Me: Hello. I have an appointment for my daughter that I will be a bit late for because I just left the hospital where I spent the night with my other child. I didn't want the front desk to think we were just a no show.

Lady: How late will you be, Mr. Gentry?

Me: I think about 15 or 20 minutes.

Lady: Hmmmm......If it were 5 minutes that would be okay. 15 or 20 will cause us scheduling problems.

Me: Ummm......Okay. You see. My son has cancer and was just hospitalized with fevers and a compromised immune system. I can't be on time because I just left the hospital.

Lady: I know. But you will mess everyone else's appointment schedules up. Let me see...Okay. You can see the PA (Physician's Assistant) when you get here.

Me [patience gone]: Look, Lady (and I did actually use that "title"). I'm going to be 15 to 20 minutes late. I called out of courtesy. My daughter will see the doctor that she saw last week and has her appointment scheduled with when I get there.

Lady [flustered]: Okay. I guess we'll squeeze her in.
Luke hangs up phone.

The practice we go to is great. They give us lots of care, listen closer to what we as parents have to say and suggest than I would guess they do for most people, and really work with us. The doctors and nurses "get it". Apparently the scheduling lady did not.

Weekend

Nathan: Daddy, what day is it?
Me: Friday.
Nathan: That means no chemo tomorrow! Julia! I have no chemo tomorrow!

Guilt

Over the last few weeks, it seems to me, Nathan's behavior has been changing. I don't think this has to do with the cancer. It was happening before the relapse, but may be accelerated (or seem that way to me) because of it. Nathan has always been a quiet, calm, respectful boy with a lot of self-control. Quite honestly, he had these traits up to the point of not being a normal acting child of his age. Well, lately he has taken to random wild outbursts of noise, having an inability to remember or act on direction, showing defiance and testing control boundaries, and etc. When I think about it, I think it is probably quite good and natural and nothing more than the normal challenges a kid of his age provide parents. The problem for me right now is that I have such issues about trying to control whatever I can in my life (including my kids' behavior) and my stress levels are, oh, just a bit high, that I'm having a hard time dealing with it. I yelled at him pretty good last evening. He was doing something for the umpteen time that I had told him not to and it just pissed me off good. Now, I think kids need yelled at sometimes. I think it should be rare though. I don't practice what I preach on this, although I try. Really I do. I feel guilty enough when I yell at any of my kids over something I know that I shouldn't be yelling about, but with Nathan that guilt is amplified. What kind of parent yells at his kid that is dealing with the fact that his cancer has returned and has just had chemo the last three days for being overly enthusiastically loving towards his 7 month old sister?

I have had some real problems with stress and lack of patience interfering with my ability to do the one thing that is most important to me, especially now. That one thing is to enjoy the time I have with my family and to be as good a husband and father as I can. I've got to get a better handle on this because things are just going to get worse.

Sorry, no comments. Even though you mean well and there may be some truth to it, this is one of those times I don't want to hear anyone pat me on the back. Yes, I'm doing the best I can. Sometimes, sadly, my best isn't good enough. Now I just have to find the trick to improving on my best.

Sprinkler Jump

Sprinkler Jump,
originally uploaded by LucasG.

Well, I've been suspiciously quiet over here...especially given the recent relapse. I've drafted a few things and then deleted them before publishing. It isn't that I don't want to share here, it is that I just haven't been able to formulate anything that seems to me to capture what I'm really thinking/feeling.

I don't mean to diminish the impacts of chemo here. Some chemos are tolerated well. Some are rougher than others. Some take some time to hit. No matter how hard or not hard chemo hits a body, it all sucks because of the mental and emotional impact of *why* the chemo is being given. The nurses say this cycle that Nathan is on will start to hit him in the next couple of days in terms of feeling bad. I'm sure it would have kicked my ass already.

Here is a picture of a 6 year old boy on day 2 of a 5 day cycle of chemo jumping through the sprinklers. He is coping well. He is bummed and emotional and probably a bit scared although he hasn't really talked about that aspect. He does still carve out some space for fun, and last night it was in the sprinklers...at least until we told him it was time to come in for his bath and bed and he melted down.

Kids understand

(This was originally attempted to be posted on June 15, before we received our bad news about Nathan's bone marrow relapse, but I had trouble getting the post to publish that day.)

Nathan turns 6 tomorrow and has been fighting cancer for over 3 years. We have never had the conversation with him or Julia (4) that cancer could cause him to die. They have asked the normal age-appropriate questions about death. We have explained simple things like some people die in accidents, and that some people die because of serious illness. We have explained that, yes, sometimes children die. They know, obviously, that Nathan has cancer and that it is a serious illness/disease. They know that illness can cause people to die. And they know that sometimes children die. They are smart enough to put it together and have been for some time. They have never taken it to the next step though and asked whether or not Nathan might die because of his cancer. So far our philosophy has been to let them dictate what they were really ready to learn and understand based on their questions. I suppose at some point this approach may have to change. First and foremost, I think they know now. If they don't, they are purposefully not letting themselves make the connection. The other big thing is that I'm now afraid what they may hear and learn from other kids now that they are in school and involved in other venues around large numbers of other children.

On the way to the airport to pick up her big brother after he just got scanned to check for relapse, Julia said to me out of the blue, "Sometimes kids die". I asked her why she was thinking about that. She said she didn't know. I just think that she didn't really want to acknowledge the reason. Later on in the drive she said to me, "Daddy, I love you. I'll love you forever. Even after you die."

Heavy times in the Gentry household.

Nausea

I'm not sick, at least not with a stomach bug, but I can't shake this feeling that I need to throw up. We may not even hear any results today. So it may linger. I won't be surprised if the results are bad, but that doesn't make me prepared. And it doesn't make the waiting any easier.

Scan Week

Ugh. Scan week is here. Susan, Nathan, and Lauren are at a hotel near the airport tonight and headed off for New York at the crack of dawn. Julia and I will hold down the fort here. I feel different about this scan week than any others. I feel almost numb about it. The stress and the general hell of it all is there, but it is somewhat muted. Each time we have to do this it is different. Sometimes I feel doom and gloom and expect bad news. Sometimes I have good feelings and expect good results. This time, going along with the numbness, I'm not leaning either way. I wouldn't be surprised if the tests show another relapse. I wouldn't be surprised if the tests are stable.

I've been contemplating posting about scans for the last couple of weeks. I've decided that I can't adequately describe what it is like. I'm not sure those who don't go through this want to know what it is like. I'm sure your imagination can do better on this one than my words ever could. Every time we do this I'm reminded that I fail to live each and every day to its fullest and to savor and enjoy my time with my family as much as I should.

So...scans are on Tuesday and Wednesday. Results will start trickling in. Send Nathan your best prayers, thoughts, vibes, mojo, etc.

Dropping the Bomb

It seems one of those great facts of life (at least from the oh so experienced and aged near 33 year old perspective) that there is a constant stream of people entering your life. The flip side is that many of those people exit your life too. Sometimes that is just fine. Other times it is a really rather sad thing. There are several people that I have lost touch with that I'm a bit bummed I don't know what is going on in their lives. There are some people that it makes me sad that I don't really know them or know them well anymore. And there are a handful of people that I have serious regrets about having let slip out of touch. I find the last category very hard to re-engage with. The emotional hurdle is great. The internet makes finding people you have lost pretty easy in a lot of cases and I think that is awesome. My experiences and satisfaction with reaching out to old friends or acquaintances is a mixed bag. I have had pleasant exchanges where it is clear I will lose touch with the party again and indefinitely. I have re-engaged with people to the point that I exchange emails with them now periodically. I really like touching base with people from the past. It is an interesting view on how much I have changed and I really have known a lot of genuinely interesting people over the years and generally they are still fun and interesting when I check back in on them.


So the tie-in for Cancer Dad is that having a seriously ill child complicates this process a bit. Sometimes these exchanges can be a bit daunting anyway. "Hi, remember me? We fell out of touch, probably for a reason, but I thought that out of the blue I might drop you an email, tell you a bit about what I've been doing for the last decade, and hope that you might do the same in return." Most of the time the reception is really positive and friendly, but it is still a bit uncomfortable at times. So the fact that I have a kid with cancer is quite understandably a huge part of my life. Now change the above to, ""Hi, remember me? We fell out of touch, probably for a reason, but I thought that out of the blue I might drop you an email and tell you a bit about what I've been doing for the last decade. I got a job, got married, had kids, live in Colorado, and have a kid with a rare and deadly form of cancer. How have you been?" It isn't like I do this a lot, but every six months to a year or so I probably get the itch to touch base with someone. I take the approach of sending a short email hitting the highlights (mostly being married to a wonderful woman and having three incredible kids) on my goings on and leaving out the lowlights. Typically I get a very positive and detailed response in return. I just got one last week. It went something like, "I'm so happy that you have such a wonderful and happy family". Well, now I feel a bit like I lied through omission. I've been through this once before where I followed this formula. At just about this time I dropped the bomb and sent the, "Well, yes, I am happy that I have a wonderful family but I feel a bit odd about having omitted this one little detail...". I never heard back from that guy.

So here is the deal. I really don't care for the most part if the people I'm reaching out to can't or don't want to handle the fact that I have a seriously ill child. I would care if these were the people that I seriously regretted having lost contact with, but I can't work up whatever it is I need to reach out to them anyway. Some of these people were good friends though and I don't feel genuine having any type of relationship with them, even if it is a somewhat superficial email-based relationship, and leaving out something so fundamental and important to my life and who I am. I also don't want to appear like I'm trolling for sympathy or attention.

So, I guess I'll reach out to old lost friends periodically and just have to drop the bomb and see what happens.

Money, Money, Money

I'm once again lurking on a support listserv related to neuroblastoma at The Association of Cancer Online Resources (ACOR). There has been a recent flurry of emails about fund-raising for pediatric cancer research. I'm not quite prepared to go into my conflicted and complex views of how money should be distributed by the government or large, national non-profit organizations like the American Cancer Society. I'm personally struggling on that front with how to balance my own emotional closeness to the topic versus the logistics of how to distribute money given disease mortality, frequency of occurrence, age at which disease typical emerges, and etc.

What has become obvious to me though is that given how money is currently distributed for research for various cancers, the rarity of pediatric cancers and perception that pediatric-cancer=leukemia=treatable puts pediatric cancer funding pretty low on the totem pole. If the big, national organizations aren't cutting it, who is leading the charge for raising money for kids with cancer? Quite clearly it is parents of kids with cancer or parents that have lost children to one of these monstrous diseases. I have not had the strength to be part of the lead in this charge. I'm not sure I ever will. I have much respect for those who find it. In some cases I'm sure it is a form of self-therapy, but it is more than that as well. It is a burden. A huge burden. The burden on parents with children sick with any serious or chronic illness is terrible, and to throw in the burden of legitimately (at least in my estimation) feeling like it is not only your responsibility to fight to get your own kid better but that you have to be fighting to find a cure for all the kids is really just insane. This is how it works though. I guess it is just one of those harsh realities. The people out there fighting for funding and for a cure are those that have been "touched" (or punched or however you want to look at it). I wish this would change, but I doubt it will. These poor kids and families have it all stacked against them. If the burden falls on those that have been stricken with this, and getting stricken with this is "rare" in comparison to adult cancers, then the progress is inevitably going to be slow. A lot of these incredible kids and families don't have time for slow and steady progress.

Kudos to those families and friends of sick kids that get out there and fight so hard to make a real difference.

A Lion in the House

Google allows you to subscribe through an RSS or Atom feed to searches of news sources. I subscribe to several different search criteria associated with neuroblastoma or childhood/pediatric cancer. I was surprised to see an article about the Nashville Film Festival pop up in one of my feeds. It seemed even stranger when the small blurb I was presented looked like this.

Nashville Scene, USA - 1 hour ago
... That Hungarian stoner comedy or four-hour pediatric-cancer documentary will be something ... journeys too are a sort of crossing over, from childhood into adulthood ...

Further review of the article revealed this blurb about a documentary about pediatric cancer. I'm not sure where I've been hiding, but I really knew nothing about this film.

A LION IN THE HOUSE (1:15 p.m.) Simply put, Steven Bognar and Julia Reichert’s devastating documentary is one of the two or three best movies in the entire festival, perhaps even this year—although its unflinching portrait of children fighting cancer over a six-year period in the Cincinnati Children’s Hospital is something any parent will dread. Themselves parents of a cancer survivor, the filmmakers document an agonizing cycle of fragile hopes, new treatments, temporary remissions and terrifying relapses: parents age and children wither over the course of the film’s gripping four hours. And yet the overall impact is cathartic rather than depressing, in keeping with the Isak Dinesen quote that provides the film’s title—which says that you don’t know what it’s like to be alive until you’ve lived with lions. Kudos to the filmmakers and to the unimaginably brave kids and parents who gave them permission to film—some of whom will reportedly attend the screening. —J.R.

I tend to think that I do not want to see this film. I suppose I'll be torn on it. On one hand I'm very curious about how the lives of cancer families are portrayed in such a "devastating documentary". On the other hand, my family lives the life and devastation of pediatric cancer. I don't really need a four-hour on-screen dose of it. I'm pleased that this subject is getting this type of attention and I really hope that it is done and received well. We'll see if I ever work up the desire to make a judgement on that myself.

Links
itvs
PBS
Interview with the filmakers
Current.org

Too Funny

I'm playing with tagging for Technorati. I tagged my last post with "pediatric cancer" and followed the link to see what Tecnhorati came back with. I got a real chuckle out of one of the tag-targeted ads that was presented. If I didn't already have me some pediatric cancer in the family, I might just be tempted by these "bargain prices".

- Bargain Prices Shop fast, Buy smart, Shopzilla for Pediatric Cancer at over 50,000 online stores. Every product from every store means you get a Bargain Price. Don't just shop, Shopzilla. www.shopzilla.com

Cancer Registry Data Made Public

A Carbondale, Illinois newspaper, The Southern Illinoisan, engaged in an eight-plus year court battle to obtain cancer registry data related to neuroblastoma cases in areas in Southern Illinois. I have only looked into this briefly but it appears that after the families of four neuroblastoma children from Taylorville, Illinois were awarded a multi-million dollar settlement in civil suit in 1998. That suit apparently claimed that the NB cases were caused by a coal tar cleanup at in 1988. I couldn't find very much information on that case in a very quick search except for references to that case in news stories about the release of registry data. A reference does get made to the case, with no real detail, in Taylorville's Wikipedia entry. The recrods released were limited for a period of 1986 to 1997 and the newspaper is apparently now going after current data from the registry.

I'm a little torn on this. I'm okay with the thought that cancer can occur because of environmental factors but that it can also occur randomly. If there is data to suggest that environmental factors related to the types of activities that occured in Taylorville (5 cases listed in a town with a total population of 11,427 as of the 2000 census. By comparison, Chicago area zip codes accounted for 87 cases during the timespan the newspaper originally requested) can cause neuroblastoma, then the general public should be made aware, or at the very least scientists and health officials should looking closer at these possible connections. My son is on the registry and I'm a bit embarrased to admit that I don't know too much about its purpose, although I always assumed that it had something to do with acquiring large enough samples of tumor tissue and etc for laboratory testing and trials and also to be able to statistically analyze trend based on various factors such as location, family heatlh history, etc. Shouldn't our public health system be doing this type of analysis? Are they? Why does a newspaper feel that they need access to the information to do this research? Are they in it for the sensational story alone? Or is there real evidence that our public health systems don't use the registry to perform this type of analysis? I guess I need to do some more research of my own.

The State resisted making the records public. I have worked for various state agencies as a consultant and while in my experiences they generally want to make information available to the public, there is also this wariness of the "slippery slope". They fear if it is too easy then they will (a) get overburdened by responding to information requests and (2) that they may lose the ability to keep some information from the public based on their "professional judgement" or the privacy of their customers. The articles I read this morning seem to suggest that the biggest argument against giving up the information is patient privacy. Patient privacy is a serious issue and it is probably a bigger issue for adults on the registry than for kids. I'm sure that there are some families that keep their children's health information very close and private, but in my experience with other neuroblastoma families, it is pretty easy to find at the very least basic information about the kids and their health. Nathan's name, where he lives, the basics about his treatment, and a bunch of other information could probably be found just by pulling information from various web-based tools we have used to keep friends and family members informed about his condition. If these papers wanted to work hard enough they could likely find the bulk of the NB kids in a given area, especially in smaller communities like those found in Southern Illinois. Given the registry data, it will be very easy for them to find out the names and other information of those on the registry. This really doesn't bother me too much as a parent with a child on the cancer registry. Anyone could pretty easily find Nathan if they were looking for neuroblastoma kids in our area. As an adult on the registry, I might be much more concerned about my privacy. Nathan as an adult might be much more concerned about his privacy than we are now.

I thought I would have a stronger opinion about all of this by the time I wrote out my thoughts, but I don't. I'm very interested in the possibility of clusters. I believe that they can exist, but I personally doubt that neuroblastoma cases will ever found to be primarily in these "clusters". I'm also interested in the privacy concerns over making cancer registry data public. I think that independend researchers have probably often been better and more efficient than public resources at evaluating data and trends and that there could be real value to allowing this information out in some form or other. I think we need to be very careful of the privacy of the people on the registry though, even though I'm not terribly concerned about that from my own family's standpoint.

(Special thanks to my legal expert, Jim B., for tracking down the link to the supreme court case.)

Technorati Tags: cancer, neuroblastoma, childhood cancer, pediatric cancer

Fear and Trembling in Colorado Springs

Part of the life of any parent is irrational fear and over-reaction in regard to your children's well-being. If you are a parent, you know what I mean and of course there are obviously varying degrees of this for everyone. If you are a cancer parent, you know that this reaction is amplified by roughly 1000 times for your non-cancer kids and 10,000 for your cancer kid. In an otherwise good but draining weekend there were a few moments of awful fear thrown in. Nathan has had a bit of a cold, or his allergies (which have been off the hook since he started chemotherapy in 2003) have been in hyperdrive. His nose has been even more of a fount of snot and he has had a cough. We handle this well. We know his sinuses are perpetually full (after all, we do CT his head every three months) and this is pretty much normal for him. On the way home from church though he started to panic because "his head hurt" and his "stomach and something else hurt". What else hurt? I asked and he couldn't explain but pointed to his throat. So I asked if his throat hurt and he said no. He often complains about his throat before he has problems with vomiting so I asked about that and he said he didn't need to throw up. He also got all red and was complaining about being hot. I cooled the van down and he calmed down eventually and then just sat and rested on the couch all afternoon and didn't really complain any more. Now I know that he is feeling crummy and that his sinuses are full and he likely just got a normal headache. But I was terrified at the time that it was much worse. It doesn't help that he has a similar emotional response to mine. If he knows it is coming, he can handle pain orders of magnitude beyond which I have ever experienced. If he is surprised by it, he just breaks down and I can understand why he would react that way. This morning Susan said he was limping after he got off the couch. Ugh. Limping is a big one for us. That was one of his major symptoms at diagnosis. I'm pretty sure his leg fell asleep on him, and that is how he explained it to me. He was laughing about it later in the morning, so I'm pretty sure that is what happened or else he would have been concerned himself.

So I'll try and shake my fear, but I'm sure it will come back in brief waves until we get a couple of "normal" days in a row out of him.

Borrowed Words

"If children have the ability to ignore all odds and percentages, then maybe we can all learn from them. When you think about it, what other choice is there but to hope? We have two options, medically and emotionally: give up, or Fight Like Hell."

-Lance Armstrong

(I like this post title because it is self-referential in that I have borrowed the title from my brother.)

April Fools

Three years ago today Nathan was in too much pain to walk and was diagnosed with neuroblastoma. I'm so very happy that I could snap this picture of him pulling his sister in a wagon today.

What are you really angry about?

Today I feel consumed by anger. If you bumped into me on the street and we chatted, you wouldn't know. If you knew me well, you might clue in that something was a bit off. Of course if you have been around me much in the last three years you might not think anything was off at all.

I'm not "mad" right now. I do get mad. When I do I'm often just letting out my anger. I get mad at my kids. Sometimes I get mad at Susan. I get mad at the dog. I get mad at idiot drivers. No. As I write this now I'm not mad. I'm angry. And angry is something much deeper and more insidious. Mad is an outburst. Angry is an emotional state I can't shake.

If I can't shake this anger, why write about it now? Saturday will mark the third anniversary of Nathan's diagnosis. April fools! That is why. I see that date coming on the calendar. It isn't circled in red. I don't have a reminder set on that date in Outlook. It might as well be and I might as well have. It just pops. And each time it pops I chase the same train of thoughts and emotions. It goes something like this...I should be happy. I should be able to celebrate it. After all, three years is a long time for this diagnosis. After all, the 5 year mortality rate is approximately 30%. This is where things start to turn in this chain of thought. Three years? That is kind of pushing five years. The chances of making five years are bad.

Then I do the fucking math (it isn't hard). The math I'm doing doesn't logically apply to Nathan, but I still do the math. I get mad when I chase these thoughts around and my anger gets fueled.

I could go on and on about what I get mad about. I could give you a laundry list of the things that spark my anger. That is what it is like too. It is very much like static electricity. I walk around all day and my anger kicks around building up energy and it has to find that point where it can jump to something else.

I spark and get mad, but what am I really angry about? Is it obvious? The cause is clearly obvious, but I'm not angry that Nathan is sick. I'm angry that life is what it is, and that seems to be a hard thing to get over. At least for me. Susan and I were living outside of the reality of life. We met young. We were happy. We picked a place to live that we liked a lot. We had good jobs and made good money. We bought a house. We got a dog. We started a family. I wouldn't have thought I was naive. I knew that the nature of life was messy, but I guess I didn't expect it to be messy for me. April Fools Day came and it wasn't funny. And all of a sudden life was what it is, messy and hard and a struggle every day. So if I had to boil it all down, I'm angry because my life doesn't match up with some ideal or expectation of life that I didn't even really acknowledge that I had. I'm angry that the reality of my life doesn't match the fantasy that I was living out and expecting to continue.

Now I could be delusional in my little pop-self-psychology analysis here. I think I'm at least on the right track. And I'm so damn mad at myself for being able to recognize at least some of the reality of it all but still unable to deal with it as well as I would like and feel that I should.

Life is messy. Get over it. Give up the fantasy. Embrace the beautiful parts of reality. Love is real and beautiful. Love cannot be fantasy. Accept the love. And give it back. Revel in it.

A Statistic

In "A Statistic" on Body Count's 1992 Cop Killer album, Ice-T tells us that, "At this moment there are more black males in prison than in college".

Statistics can be dangerous and manipulative and if you want to fight with me on this I'm sure you can throw this back in my face. Here is my statistic though. Think what you want about it.

In 2002 more children died from malignant neoplasms in the United States than people (adult or child) died from terrorist attacks world-wide in 2004.

I got my data from the CDC's National Vital Statistics Report on Leading causes of death for 2002 and from a 2005 Washington Post article on the release of global terrorism statistics by the National Counterterrorism Center (NCTC). I used 2002 and 2004 because in my quick search those seemed to be the most recent available data. I did not pick the years because the data supports how I would like people to think about this.

I'm also acutely aware of the danger of putting forth numbers as the primary decision point for making decisions like government funding, where you should donate charitably, how to prioritize legislation, and etc. If this is solely a numbers game then sick kids get left in the cold. So I'm clearly a hypocrite and I want to manipulate you with my numbers and then tell you to ignore all other numbers. So be it.

The next numbers I want to dig up relate to how much money our government spends yearly fighting their "War on Terror" versus how much they allocate to pediatric cancer research.

And how is your kid's immune system today?

From an email from one of Nathan's doctors yesterday:

PHA shows normal immune function.

That is pretty cool. Really it isn't something we were terribly worried about. It means we can stop the weekly antibiotics to protect his lungs from infection. I can't say definitevly that my PHA would show normal immune function. Can you?

Serviceable Big Man

I wanted to spend more time on this (common theme in everything I attempt these days) but I'm just not finding it so I'll stick with half-assing things. I'm a big basketball fan and like all fans have been watching the tournament (although contrary to popular belief the tournament is now over). So I'm watching some known team play one of the unknowns. In this case there was no "Cinderella" in the works, just a good but undermanned team playing tough but not going to win against a power conference squad. One of the smaller team's big men pulled down a rebound and the announcer says, "So and so sure is a serviceable big man". What a compliment, huh? As I have thought about that over the last week it has become a metaphor for me. I realize that I'm a "serviceable big man". There are a lot of things that I do just fine. I do them fine because I have natural advantages. My size is my upbringing, my socio-economic status, my education, the support I get from the ones I love, etc. There are a lot of things I spread my time across. And I don't excel at any of them. Am I better than average? Hell yeah. I'm playing D-I, baby. Can I hang with the true big boys though? No.

I'm a serviceable big man.

Where we choose to live

This has to be quick. It is Saturday and I'm supposed to be working. This is a big deal because when I work on a weekend Susan has to work too. I haven't posted here for a bit but I have a couple of posts knocking around my head. I feel like I won't be productive if I don't get something written out here. Spoiler: This post ends on a bit of a morbid tone.

So I got to spend quite a bit of time with one of my closest friends last weekend and as we were driving somewhere he says, "I don't know why I don't spend more time with the people I love". The context was that aside from his nuclear family, most of his dearest and closest friends live far away. This is something I've struggled with. I'm working actively to make seeing family and my close friends a higher priority. It is tough financially and from an effort and planning standpoint and while I wouldn't say I was failing, I wouldn't say I was succeeding either.

This raises a bigger question for me which is, "Why do we choose to live where we do?". I won't do a lot of history, but Susan and I lived in Northern Virginia when we met and married. We say we felt a lot of "push" factors from there and that is true, although I think they may have been more internal and about us than about the place than we usually talk in terms of, but perhaps that is a post for another day. We chose the Springs for a variety of reasons. We felt a strong pull to be close to one of our sets of parents, but at the time thought that if we did that it would probably be it and we wouldn't ever try somewhere else just for us, but that if we went somewhere just for us now that we would have enough of a pull perhaps to move us nearer our parents in the future. Did that make sense? I like the Springs a lot. I have no roots here other the ones I'll explain in the next paragraph. Susan has some really great friends here. After roughly eight years here I have some people that I think could possibly be on the fringe/verge of becoming good friends. We have the church now and I'm attached to Susan having the choir because she loves it so much.

We aren't and haven't seriously talked about moving for a long time, so please don't think that is what I'm getting at here, but in general I can easily say that I would like to live close to my parents. I would also like to live close to Susan's parents. We can't have both, but we could choose to have one. There are a bunch of reasons that moving is hard for everyone and we have those like all people do. Here is where cancer comes in though. We have a bunch of additional reasons that moving would be hard. We really like and respect and have a great working relationship with Nathan's doctors here. Now there are good doctors in lots of places, but we have heard a lot of horror stories about pediatric oncologists in smaller communities and even in communities comparable in size to the Springs. I don't want to give up having doctors and a clinic close that we are comfortable with, and just as importantly that Nathan is comfortable and at home with. There is also the general stress factor. Nathan is in a great place healthwise, but there is an underlying stress that is inescapable for any cancer family. There would be benefits to being close to parents/grandparents though. There are the clear emotional benefits to everyone. There is also the selfish benefits that are one of my biggest regrets for not having moved close to family. Those are the ability to have built-in help and a means to escape with Susan. We have friends that would watch our kids. We have people that truly love our kids and us here, but it isn't the same as having parents to drop your children off with and say, "We really need/want to get out of town alone for a weekend". So there are those obvious benefits, but I doubt I could handle well the additional stress of even thinking seriously/considering a move. I barely hold on as it is (that is another post I'm working on).

So here is where things turn horribly morbid, but I can't help but think about them. If we stay here the more likely it is that we will lose Nathan while we live here. I don't pretend to know what it would be like to lose a child and how I would feel and react, but I don't know if I could leave here very easily if we lost Nathan here. I doubt I would have much attachment to a physical resting place, but I wouldn't rule that out. Right now all of my children's' lives have been lived here. All of my memories of my children involve Colorado Springs being our home. In some ways my perception of my family only exists here in the Springs. If I lost any of them here now, I'm not sure I could leave. Intellectually I know that the people I love live in my heart and I take them with me everywhere, but emotionally they feel tied here to this state. To this city. To this house.

St. Baldrick's

We spent a great weekend in Chicago. The main reason we went was to spend time with family and friends but the reason we picked this particular weekend was that our friend Matt was shaving his head to raise money for pediatric cancer research. St. Baldrick's is a tremendous and I think overlooked event. Kudos to Matt who personally raised over $5,000. Matt does this because he believes it is a worthy cause, but he also does it as a way to show support for Nathan and our family when at times I know our friends feel like they can't really help us. Thanks, Matt.

The event that Matt participates in is at Fado Irish Pub in downtown Chicago and by the time everything is counted they think they will top $200,000. It is a great time. Nathan particularly enjoyed the event and even got to help shave Matt's head. He had a great time. I think on some level he knew he was someplace that he normally wouldn't be allowed to be in. The kids got to sit and drink pop and munch on bar food. The event organizers were happy to have a cancer kid in the house and all of Matt's friends that came out really made the kids feel comfortable while they were there.

Special thanks to Matt and everyone who gave to his fundraising.

Is "ordinary" good enough?

We have strived to live as "normal" and "ordinary" a life as possible while fighting Nathan's cancer. I think we aim for the "ordinary" target for a variety of reasons. Some of them are selfish. I need to do normal, everyday things so that life isn't always about Nathan's illness. I think there is a solid argument too that Nathan, Julia, Lauren, Susan, and me deserve a bit of normalcy. And while there is so much ugly extra stuff going on like surgeries, chemo, radiation, bone marrow transplant, "pain", scans, bone marrow aspirations, and etc, it almost seems noble to say, "Through it all we just try to provide Nathan and our family with as normal a daily routine as possible".

Is ordinary good enough though? As much as we may strive for ordinary and normal, Nathan is special. Sure, all kids are special. Nathan is extra special. There is no getting around it. More than that though, do we owe him more? Specifically, if he may not be with us very long, should we not strive to provide him with an extraordinary life experience and not an ordinary one?

I think we strike the right balance and I think it is right to fall on the side of "ordinary" because I just don't think I could handle focusing on doing more or providing more to Nathan than we normally would because to do so would be not only to acknowledge that he may die from this illness, but it would feel in a way like giving up hope that he may not. I'm not ready to live like he is dying, because he isn't. But sometimes I can't help but feel like maybe we should be giving him more because he may be.

Three Months

You should read my wife Susan's Living my life three months at a time post at her blog. Scan cycles are hell and the pressure the short interval puts on a person and family are insane. Susan captured it well.

Three

We were in The Big Apple this past week for 3-month scans and a chance to sit down and plan strategy with Nathan's doctors at MSKCC. Nathan is in a "second remission" after achieving "no evidence of disease" (NED) status and a soft-tissue only recurrence. We are primarily waiting for a Phase I clinical trial to open that has a focus on preventing multiple recurrence, which is common in aggressive cancers like neuroblastoma. One of the points the doctor touched on is that with new therapies more and more children that have recurrence are achieving a second remission, but with many of those having a second recurrence, there is obviously so much need for additional therapy. Susan began asking about the interim treatment Nathan is receiving (chemo followed by a biologically based therapy) and the doctor explained that they are currently treating three (yep, only three) children (including Nathan) in Nathan's situation with a soft-tissue only recurrence. The rest of their recurrent patients have bone marrow involvement. We have always felt good about the fact that Nathan had soft-tissue only recurrence that could be treated surgically, but hearing that they are only treating three patients with this scenario really hit home how much we will forever be flying blind with Nathan's care. MSKCC claims that they see 80 new neuroblastoma patients each year and this number represents more patients than any other facility in the country. And out of all of those patients, Nathan is one of three with a similar status.

There are pluses and minuses to each facility and philosophy out there regarding neuroblastoma treatment and sometimes parents can get pretty heated over discussing the relative merits of different facilities and therapies. I explained to a friend we saw over dinner in NYC that if we are going to be having decisions about Nathan's care based on what amounts to instinct or gut feelings, then I want those decisions made be people who see this disease exclusively, hoping that they have a better instinct regarding its behavior. There may be other facilities that have multiple kids in second remission after a soft-tissue only recurrence, but there can't be many and since Nathan has had continuing care at MSKCC, there is nowhere else where they have kids in similar circumstances that have had similar past treatment.

How Does it Feel?

What seems like ages ago (December 2003) for this first time since his diagnosis Nathan had "clean" scans. I felt a weight lifted from my shoulders that day and cried tears of relief as I pushed Nathan to our temporary apartment in NY on the way home from the hospital. Since then we've had several sets of scans. Most of them were clean. In June they showed relapse. This past December they were "clean" again. I occasionally read another cancer dad's journal. He writes a journal about his daughter and her treatment. It isn't much like this one has started. It is more like what Susan does at Nathan's CaringBridge site. He described in one post about the great joy and happiness he and his wife feel every time they get good scan results. It isn't like that for me. Sometimes I wish it were. We heard today that Nathan's latest scan results (at least the prelims anyway, things could change) are "clear". There is relief, yes, but it isn't the great weight lifting.

I think it is like taking two steps backward and one step forward. There is no way the good feelings balance the amount of stress and apprehension that goes into it all, and that is a real shame.

I sure wish I felt like celebrating.