August 6, Patio

Saint George and the dragon still clash above our fireplace.  Even in battle the knight's face, and the postures of both combatants, are prayerful and calm.  Like Rocky, though, Angela and I are now spending much less time at the hearth, and more time in the sun.

We visited the radiation oncologist last week.  He tells us that there has been no change on the most recent MRI compared to the last.  This, of course, is very good.  He has ordered a repeat skeletal survey, xrays of the rest of her bones, to be sure the cancer has not taken up elsewhere.  Angela, smiling, tells him not to worry.  She says, for the moment at least, she is feeling better.

It is hard to know if our bear's symptoms have improved.  Her determination, though, has continued.  Still she is up repeatedly in the night to "reposition."  When she is lying down, unless her arms are stretched out straight, they quickly grow numb.  When she drives to town she is sure to nap beforehand lest she fall asleep at the wheel.  There is, still, so much care required for simple tasks.  Irrespective of her persistent symptoms, though, our bear, clearly, is getting stronger.  She is driving herself to town now a few times per week.  She is walking Rocky down the highway a little further each day.  Wherever she goes, however far, she seems now to come back with photos.  She takes her iphone everywhere and pays close attention to everything.  She has captured some remarkable cloud formations, and at least one oddly beautiful insect.

For Angela's birthday yesterday we made a trip to Ottawa to visit the Van Gogh exhibition.  He too was crazy about tree trunks, insects, and clouds.

charity and good homes for old books

We boxed up most of Angela's library recently.  Still she cannot write without tingling and numbness.  She cannot read without sedation.  She cannot do either without a certain amount of grief.  For the moment, at least, we need some space on our shelves.  Today, we are rearranging our furniture.  We have the happy feeling that there remains plenty of space for new things.

We have started, it seems, with canvases. Angela continues to paint.  After some self portraits she has painted a couple of me.  Somehow in the paintings I am restful and calm.  In one I am asleep.  A pillow is under my head.  My eyes are shut.  In another I am slouched in a chair.  Angela, with her painting, is wishing me restful dreams.  It is true that the dragon had tired me out.  In recent months, though, as if to restrict my life as much as Angela's, I have been taking on many more responsibilities in my work.  My workdays are long.  In this way Angela and I retain the same pace.  I am grateful when I am away for the photos she texts to me of the clouds, and of Rocky's shadow on the grass.

We celebrated Angela's birthday last night with some wine.  Happily a glass of wine has become palatable again.  The sun has been beating down heavily on everything this summer.  Happily it seems to have slowed everything down.  We moved from the fireplace to the deck.  Forgetting the dragon for the moment we are toasting Angela's health.  Remembering Saint George we are staying prayerful and calm.

We know it has been a long time since I have written on this blog.  I do not have the strength of Van Gogh, whose paintings I now love, nor of a polar bear, or of Saint George, but I am grateful for our friends, and, ultimately, I will try...to keep you posted.

April 16, Boston

African sculpture at the Boston Museum

angela's take on it

Angela and I returned yesterday from a trip to Boston.  The snow has long since melted from our trail.  The grass in the meadow has become green again.  The leaves on the Poplars are once again rustling in the wind.  Ready or not our bear has been trying to respond to the call of spring.

The warmer temperatures and the early return of so many birds have been helpful, but Angela has been inspired as well by the most recent visits to her doctors.  The radiation oncologist was very enthusiastic about the destruction caused by his beams.  He printed before and after MRI images of Angela's spine and tumour.  Happily, he circled pertinent areas in red ink to add emphasis as he spoke.  Clearly he was impressed by the changes.  True, there remains a mass, maybe a few, but we cannot know as yet what these masses are doing.  If they are still growing the change will not be visible on MRI for several weeks.  This doctor, a true general, will apparently be surprised if the enemy survives such a direct hit by his weapon.  He will nevertheless watch closely.  We will be back for another MRI in June.  In the meantime our medical oncologist is unexcited.  He is looking in a completely different direction anyway for what he expects, at some point, will be the next assault.  Without meeting us he sent his resident in at our last appointment to tell us that Angela's blood work is basically unchanged since our previous visit.  I suppose we will be back for repeat blood work in a few months.   In the meantime I am very proud of my great bear.  Contrary to the medical oncologist's expectations, she has surely levelled deadly blows to the mischiefous dragon!

Somehow a trip seemed necessary.  Should we not be celebrating?  Somehow it seemed right to escape.    We drove to Boston.  Angela could not contemplate being on a plane as yet so we picked a place we could drive to.  We had a few days in a nice hotel.  We had a couple of long walks.  We met with our good friends Catherine, Terry, and Lou who were also there, conveniently, "on business."  We had, once again, and like old times, great laughs.  We did, certainly, a lot more than we might have done only a few weeks ago.  We are prepared to call this progress.  Great progress!

It is understood, of course, that this trip was not altogether easy.  It is understood that there is still pain suffered.  Angela, today, has done very little.  Her arms, unfortunately, are as painful and numb today as ever.  The medications, in a different way, are also numbing.  Victory, to be sure, is relative.

We did not know before we arrived to the city that the Boston Marathon was scheduled for today. On the morning that we left Boston our waiter at breakfast asked Angela if she was in town to run the race.  Although he seemed to immediately understand that this was not likely, he could not take back the question.  Angela was delighted.  "Yes," she said.  "Yes, I am here for the marathon."  She smiled brilliantly and we all had a good laugh.

Spring happily and cruelly has surely arrived.  Our bear, compelled, wills to go further still.  Evidently there will not be progress without pain.   The fight is now a marathon.  We are pacing ourselves.  In time, my friends, we will be in touch.

March 18: Forest Trail

Angela and I are just back from a walk in the woods.  Inspired by such a warm and beautiful day so early in the year we went further than I expected.  Soon after leaving we hung our sweaters and jackets on tree branches and continued in only t-shirts.  However slowly, we walked very triumphantly on the soaked trail.  Still how curious to find, now after many days of warm weather and much rain, patches of ice and snow persisting under our feet.

Angela's most recent MRI results are difficult to interpret.  Apprehensively we visited the neurosurgeon on Thursday to discuss the results.  It is hard to know whether it is a quirk of his personality, or the circumstance itself, that compels this gentleman to shrug his shoulders so often.  He brought the images up on the computer screen and compared the previous MRI to the most recent.  He showed us the space where the body of the first thoracic vertebra should be, and how there is now neither a bone nor a tumour there.  He showed us how the remaining bones and fragments "caved in," more or less, in a stable pattern.  By reference to some obvious kinks in the line of the remaining vertebrae, he reassured himself of the legitimacy of Angela's ongoing complaints of back pain.  "Yes," he said, "one can imagine at least a few nerve roots being squeezed along there."  Proudly, though, he demonstrated how the spinal cord itself is no longer pinched by a tumour.   Hesitatingly, but finally, he showed us a remaining mass, "perhaps 6 or 8 cubic centimetres in volume lateral to the cord, on the left."  "Yes," he said, "that's quite consistent with the numbness you describe in your left hand."

It was about this mass, of course, I felt we should speak.  Is it growing?  Might it still be shrinking?  Does it require further treatment?  To these questions, though, our proud and humble neurosurgeon, speechless, repeatedly shrugged his shoulders.   What he did know with certainty was that surgery, still, was ill advised.  It is simply not likely that with surgery he could get all of the tumour out.  Any surgery, furthermore, is likely to result in more pain and dysfunction rather than less.  "Best not to touch it," he said, and with this in mind he also counselled against physiotherapy for the time being.  "We still don't know if things will get better or worse on their own," he said, "better to watch and wait."

Our neurosurgeon wants to see Angela again in 3 months.  He is managing the spinal column.  He said it was for the oncologists to manage the tumour at this point.  In the meantime, remembering that Angela was "a professor of some type," and as though not to be completely useless, he wondered if hiring a transcriptionist would be helpful.

And so we turn to the oncologists.  Apprehensively, again, we make our next visit to Kingston tomorrow to see the radiation oncologist.

With signs of Spring our bear is coming out of hibernation.  It is no small thing that we managed a walk in the woods today.  It does not matter how slowly and cautiously we walked.  On Friday we managed a trip to the dentist in Toronto.  It does not matter how tiring it was.  Angela is convinced that she can drive safely at this point, if only a short distance.  Although it remains to be seen if she can make it to anywhere meaningful before her hands give out, we will soon give it a try.  She grows tired of isolation too.  Although she wonders how entertaining she can be for guests, with Spring, she hopes she will have more visits.  Winter, it seems, was for stones and orchids, spring, we hope, will be for visits with more friends.

We choose to find solace in the ice and snow on our forest trail.  Though persisting, it is surely melting.  We take hope, for the time being, in the idea that the tumour too might still be melting.  We will, my friends, find out soon enough.   Melting snow, so slow, can, it proves, be painful to chronicle.  We will, nevertheless, do our best.  We will, in continued gratitude, be in touch.

February 21, Atelier

The orchids, miraculously, are thriving.  Joined by hyacinths, violets, and now two vases of tulips, they almost efface the winter seen behind them.

Angela, deceptively, is thriving too.  We were joined by friends both this weekend and the weekend before.   For both occasions Angela discarded her collar, partook of some red wine, and, generally, was in fine form.  During the week, perhaps to oppose as directly as possible her weakening hands, Angela has taken up drawing.  Perhaps to confront as directly as possible her changed and changing features, she has started with a portrait of herself.  The slow lines, produced in steps, as allowed by her poor hands, seem, in drawing, to be less frustrating, more pleasurable, than in writing.

Today the fire is blazing in the fireplace.  After working through the long weekend I have a day of rest.  As I write this Angela sleeps.  Rocky sleeps too.  Still an afternoon nap is inescapable for our Angela.  Still she sleeps on her right side, a pillow between her left arm and her body to keep her shoulder at the right angle, another pillow squeezed under her side behind her to keep her from rolling on her back.  Still, after so many months, the same position.

Angela ran her hand through her hair yesterday to show me how much it is thinning on the right side.  We agreed this was due to so much time against the pillow.  We are not certain why her hair has grown so very little these last few months.  Her thin and irregular hair is one of the features she confronts as she does her self-portrait.  Other features include her swollen face and the surgical scar across her throat.  In the portrait this scar is covered by the plastic collar.  In the portrait as well, I am happy to say, all these features are eclipsed by her beautiful smile.

As I write this it is almost, but not quite, snowing outside.  There are tiny snowflakes widely dispersed that crisscross and, at times, hang motionless in the air.   We do not know what to plan for the spring or summer.  We are still unwilling, it seems, to press our luck.  We look together at Angela's changed and changing features, both in her portrait, and in the mirror.  She worries perhaps that I have not yet seen them, and one day will.  I worry that she will one day fail to see herself, my regal bear, as I do.

In the morning while we drink our coffee we look, at times, beyond the orchids to the frozen meadow. We hang like such melancholy snowflakes in the air.   Thankfully, our friends, there is drawing.  Importantly, there is strength to draw.  There is writing too.  We will keep in touch.

February 5, Bear Trap

We read recently that tomatoes and red wine are protective against cancers.  Poor Angela.  "Who has eaten more tomatoes than me?" she asked.  She did not, of course, even mention the red wine.

The great fight has slowed down considerably.  Angela's pain does not return as violently as it did only a couple of weeks ago.  She sleeps peacefully through the night, and with the most recent change in her medications, her mornings too are more bearable.  Although still compelled to nap for a few hours in the afternoons, she seems, to me at least, to have more energy.

I return home in the evenings with the groceries.  Angela hates that she cannot go for them herself.  She sometimes tears the collar from her neck and triumphantly discards it, but, soon enough, she puts it on again.  Typing still makes the tingling and numbness in her hands worse.  Her general comfort and wakefulness lasts only so long if she does not remain still.  Our bear, with more energy, finds herself, nevertheless, quite trapped.

I, myself, am torn.  I cannot say to what tragedies I have been called to in recent weeks.  It is at once a gift and a curse of my profession that I find myself at times in a position to make a difference for people in anguish.  I cannot go there though, there where people are otherwise alone, there where it it is possible to make a difference, without, to some extent, my mind being stolen.  I am a repository of terrible stories.  Angela, some days, is having to wait.  Trapped, she remains, nevertheless, wonderfully patient.  I arrive home, distracted, with the milk and the honey.  Angela, focused, is ready to help.

Regretfully, I have been unable to write on this blog before these two weeks.   I think, in retrospect, that I had been stolen away.  Joyfully, in the meantime, we have continued to watch British sit-coms.  The great fight, un-ended, has only changed rhythm.  We imagine, like us, the dragon too is torn and resting. We are all catching our breath.  In this we are aided by the many suggestions for opera and television that have been sent to us by our friends.  We are grateful not only for your suggestions but for your patience.  Our bear is not alone.  My friends, let us keep up the fight, and yes, let us be in touch.

January 22, Field of Grass

My ritual in the mornings includes scrubbing the fireplace window, raking the coals, and lighting the fire.  Rocky is typically back from his first exploration of the meadow by the time I finish.  I fill his bowl, and turn the tap on for Alice to drink.  Angela, in the meantime, waits for her morning pain medication to take effect.  "Crying helps," she reassures us.  Rocky now places his chin on Angela's lap when she cries.

The dragon, as we call it, is reliably most vicious in the mornings.  We are adjusting Angela's medications regularly.  We are glad that she is now sleeping peacefully through the night.  We have not been able, though, to avoid her morning pains.  It is the stabbing in her back that is most difficult.  She takes her time to raise from bed.  Bravely, though, and without fail, she is making the coffee by the time I am taking my shower.

I linger in the mornings to the point, each day, of being late.  My schedule, though, is becoming as full as it has ever been.  Sadly, in my work, I have attended to some uncommon, and unspeakable tragedies this week.  I have been, with colleagues and patients, deep in reflection on life's cruelties.  I dreamt, in the midst of this, that I was walking through a field of grass.  Foolishly, and despite great care, I kept dropping Angela's pill bottle.  I fell to my knees each time and searched desperately for her pills within the grass.  At first I gathered them easily, but gradually I realised there were pills everywhere, more than just Angela's.  They were of so many shapes and sizes that I could not tell which were hers.  I crawled around stupidly and was dumbfounded at how surrounded we are by illness.

When our good oncologist had told Angela that there is no cure for multiple mieloma, Angela reminded him, to his own apparent dismay, that there was also no cure for life.

When I am at work Angela, our great bear, is at home, most often, sleeping.  Her battle with the dragon each morning seems, before noon, to tire them both.  Although her pain seems to improve she remains, through the afternoon, quite limited by fatigue.  She continues to steal what she can, moments here and there, to get some things done.  Despite her pain and fatigue she rides a stationary bike for 15 minutes each day.  On one afternoon she rearranged some shelves.  She is now visiting the International Mieloma Foundation website from time to time because our good oncologist recommended it.  He said that it saves him from having to tell people "the bad stories" himself.

We both, upon our parting in the mornings, look forward to the evenings.  When I drive to and from work, passing the cows and snow covered orchards, I am now listening to an audio course on Renaissance church music and early opera.  This is a surprise to me.  I have no taste any longer, or at least for the time being, for popular music.   There are feelings these days that I have no expression for, an intensity of which I do not want to let go of.  Words and thoughts are not enough.  Opera, in particular, seems to help.    I am crawling around stupidly, but, amongst the horrors, I am uncovering some beautiful things.

Oddly, while I have lost the taste for popular music, Angela and I have acquired a taste for popular television.  We are still watching British sit coms.   We look forward to the evenings when with Perrier, clementines, and a box of chocolates we watch comedy on the big screen and, reliably, steal true, honest laughs.  We welcome, our friends, any suggestions for good television comedy or for opera that you might have.  We continue to trust in your patience, well wishes, and your prayers.  We will continue, of course, to be in touch.

January 13, Games Room

Amused, Angela tells me she fell asleep last night amidst thoughts of death.  "It couldn't have been too bad," she said, "I still fell asleep."

I am glad to report that our bear seems to be gathering her strength.  She is at least out of bed more often compared to a few days ago.  There are fewer headaches.  I am hearing her laugh again.  The steroids dropped her so very hard last week when she stopped them, but now she is picking herself up.

Two days ago we met with the oncologist.  Without waisting time he told us he does not recommend chemotherapy yet.  In this type of cancer he typically waits until there is more obvious impairment in blood counts (low red blood cells, white blood cells, or platelets), or in kidney function.  Doing chemotherapy before these sorts of problems arise does not, ultimately, increase overall life expectancy.  "Better to wait," he says, "wait and watch." He will see us every three months for tests.  In the meantime Angela will be vigilant for any new pain that may arise in her spine or other bones.  

Is there a chance that these new problems will never come?  Is there a chance that the radiation therapy already done is all Angela will ever need?  Yes, there is.  Our good oncologist estimates the likelihood of this, however, at 20%.  "There is no cure for multiple myeloma," he proudly cautions.  In  Angela's case, this might be the type of myeloma that, as he says, "smolders in the bones without causing problems for a long time."  On the otherhand, of course, time may be shorter.  

Long or short, if the time comes, our good man will treat this cancer aggressively.  A man of numbers, it sounds as though he, himself, would bet on giving Angela both chemotherapy and a bone marrow transplant "sooner or later,"   but not now.  "Why ruin the winter?" he asks.  

Regretably the oncologist was not surprised that the pain and weakness in Angela's hands had not improved.  Plainly, he told us that these symptoms likely won't get better even as the tumor recedes. Reassuringly, he said they should not get worse.  Ultimately, moved by the hard plastic collar still supporting Angela's neck, he referred her to an orthopedic surgeon who has experience injecting "cement" between vertebrae in unstable spines. 

At the end of the meeting Angela took this card player by the hand and thanked him for being straightforward.  We will see him in three months.

Hope is simultaneously given and taken away.  

There will be time, however long, to tend to our orchids.  This morning, happily, we enjoyed our coffee with foamed milk while Rocky, once again, explored the meadow.  In such moments even a plastic collar is no great matter.  

We, of course, do not know to what extent our good man's numbers apply to polar bears.  Saint George, of course, is still fighting the dragon above our hearth.  Invisible hands still hover around us.  We are still the recipients of the fondest wishes and prayers. We return those wishes and prayers one thousand fold.  Our friends, we will still...be in touch.