Not Just A Little Sobering

After being in treatment for acute leukemia since February, I’ve come to realize that there is no real routine to speak of, especially since arriving in at the Puget Sound Veterans’ Health Care System. I can arrive on time at 8:00 a.m., get my blood drawn with all my compadrés, get my IVs running, and get my golden ticket to head back to the hotel only to see the MTU’s number in my caller ID. It could be as innocuous as letting me know about an appointment, changing my dosage on a medication, or having me come back in for something unforeseen. Any way you look at it, I’m on a short leash and it’s just part of the big picture of treatment. Some days a pain, some days a reassurance, but always something of which I have to be conscious…and there really are no days off, even if I don’t have an appointment at the big white building on Beacon Hill.

Med management is, as I’ve said before, an hour-to-hour undertaking and I’m my own best advocate when it comes to my healing. It means being brutally honest in how I’m feeling at the risk of sounding like a hypochondriac and asking a lot of questions.

This week has been a tough one with respect to the details as well as the big picture, but it started with what might otherwise be seen as routine. Because of my lungs, my attending physician has asked that I come in every day rather than Monday, Wednesdays, and Fridays (which, incidentally was reinstated as of this morning…see? Everything is always in a state of flux!). Outpatient rounds typically devolve into a quick social call where the entourage of medical folks ask how I’m doing, exchange a few details about the lab results from my blood draw with each other, perhaps adjust medication a bit, and move on to the next patient. It’s pleasant enough and they take all of five minutes, maybe ten if Austin or I have questions we’d like to discuss.

Wednesday was really…really different.

It was a conversation that hit me out of the blue about a topic I’d certainly mulled over in my mind, but that I was having said conversation with my attending physician, the head of the Bone Marrow Transplant Unit, took it out of the realm of academic and into the real.

Without preamble, he pointed out that my pulmonary function test from that morning didn’t show any improvement over the previous week, something I already knew. Where he went with that was not just a little sobering. He pointed out that with any intubation, the likelihood of being extubated successfully becomes smaller. He didn’t want to even offer up any statistics in that my survival from the previous two intubations was seen as pretty remarkable. In fact, he suggested that if I were required to go back on a ventilator, the possibility of me regaining consciousness would be unlikely.

This is me in the MICU on a ventilator for the second time. The machine is breathing for me and it was actually a terrifying experience for me in that any time I had to cough, a pulmonary technician had to "help" me and it felt like I was drowning. To communicate, I had an old school clipboard. I'm trying to be a bit funny to make the best of a very bad situation. I was in this contraption, catheterized, being fed intravenously, and really unable to do much of anything for almost a week. Yeah, it sucked, but it kept me alive.
 

How’s that for a conversation opener?

Who, in their right mind, would submit to that? I, already had two awful, PTSD-inducing experiences on the ventilator and to hear that submitting to a third time would most certainly end my life was a bit much. Now, bear in mind, that I’ve already come to terms that my time could come and in reality, I’ve lived a great, fulfilling life, but I’m not ready to cash in the chips yet! I’ve got too much yet to do and too many life experiences yet to live, so this is not something I want to hear. Who would? But I’m still in treatment and there are “TRM – Treatment Related Mortality” statistics for a reason.  People really do die because the treatment is rough, let me assure you, but I will survive, I will survi-i-ive (sing it with me!)

One of the entourage was the staff psychologist and we talked about this death thing in real terms. No, I’m not dying and yes, we’re all still fighting this lung crap with a vengeance. No one is giving up. I will say that I refuse to die in a hospital if at all possible and as much as I find my adopted home town of Seattle endearing and welcoming, my home is the cradle of the Wasatch Front in Salt Lake City and I’ve made arrangements with the University of Utah for the disposition of my remains to be used in training our next cadre of medical professionals as well as donating my organs. It just seems like the responsible thing to me.

I don’t need to tell you that the whole ordeal was a really tough one. I was a bit out of it for the rest of the day. I needed to decompress, but how? I shed a tear or twelve, talked it out with family both email and on the phone and had a barrage of questions for the doctor the next day.

I am pleased to say that the doctor clarified a few things. First, it was a conversation that should have happened after the first intubation, but just never did; Second it was a possibility, not a likelihood; and finally, he apologized for springing it on me the way he did.  Afterward, I felt like he was really trying to work with me rather than back me into some corner. I explained my position and we moved back to the pleasantries that we were used to. Bottom line: game on with the lungs. I can do this and we’re all on the same page once again.

So, we’re back to perpetual med dose changes, being inconvenienced by a short electronic leash, and the sound of IV pumps swishing away and making harsh electronic noises – all things that indicate the war on steroid-induced myopathy, lung malfunction, and leukemia continues in earnest. As tiring as that has become over that past several months, I again say, “Game on!

Be well, stay strong, and much love to you all.

Today’s music is from Dan Fogelberg – Phoenix

I have cried too
I have cried too long
I have cried too
I have cried too long
No more sorrow
Got to carry on

Found deep water
Before I'd even learned to swim
Found deep water
Before I'd even learned to swim
Never thought I'd
See the sun again

Once I was a
Once I was a man alone
Once I was a
Once I was a man alone
Now I've found a
Heart to call my home

Like a phoenix
I have risen from the flames
Like a phoenix
I have risen from the flames
No more living
Someone else's dreams

I have cried too
I have cried too long
I have cried too
I have cried too long
No more sorrow
Got to carry on

You almost had me, old lady
You almost tied me down good
You played the lady in waiting
And I waited as long as I could

Too long the songs have been silent
Too long the strings have been still
I never knew what you wanted
And I guess that I never will

Like a phoenix
I have risen from the flames
Like a phoenix
I have risen from the flames
No more living
Someone else's dreams

I have cried too
I have cried too long
I have cried too
I have cried too long
No more sorrow
Got to carry on

Yeah, yeah, yeah
Yeah, yeah

Every Day is a Bonus

I’ve met a lot of people with cancer since my own induction into the NIHF (Nasty Illness Hall of Fame).  It’s like suddenly noticing that everyone is driving the same model of car you just bought. Sometimes you spot other survivors because of the awesome hairdo (i.e. lack thereof) or the PICC / port. Sometimes there’s just that vibe and you find yourself striking up a conversation with a perfect stranger as if they’re old friends. Those conversations aren’t at all uncommon and typically the people leave you feeling buoyed and encouraged from their positive outlook. After all, we’re all survivors and it takes a certain je ne sais quoi to keep breathing when the chemicals may be messing with your lungs.
 

 

Sometimes that positive attitude isn’t enough and the cancer takes a few fellow soldiers out. I’ve met two such people who were processing the news that their bodies weren’t responding to treatment any longer and I was on the other side of a curtain when a social worker was discussing palliative care options with someone who had just received that news. Just like the cancer diagnosis itself, just hearing the news of someone else’s impending demise stops you in your tracks.  It’s not so much a ‘there but for the grace of God go I’ sort of thing as much as it is reality when you’re battling cancer at all.  I don’t feel sick, but I know if I do nothing, I’ll be having that same conversation with someone with a practiced sad but efficient countenance. My doctor said as much on Monday. It’s powerfully sobering…and just like a good alcohol buzz, coffee doesn’t make this go away either, but it is, to be sure, the ultimate buzz kill!

I started writing this blog for two main reasons. Naturally, it’s a way of ‘controlling the message’ and letting everyone know what’s going on with a rather long-term, complicated condition I’m working through. The details are many and easily misinterpreted, so I try to use this forum to keep everyone who cares in the loop at the same time instead of saying the same thing over and again. That really gets emotionally taxing. But really, I write for me. Writing has always been a catharsis, a way of expressing how I feel and as a way of preserving some modicum of sanity in a situation where I feel like I’m held hostage to a situation that I did nothing to bring on and can do nothing to ameliorate. Admittedly, in the process of putting information out there, I tend to be a bit self-deprecating and flippant, but underneath it all, I can be one scared puppy on occasion.

Now, I wouldn’t try to start reading between the lines and wondering if I’m OK because that just opens up a new can of worms and if you’ve ever played with worms, you know how messy that can get! So, let me spare you the psychoanalysis and just come out and say that I’m OK. I will also say that while I accepted academically, a long time ago that I have cancer and am going to fight this son-of-a-bitch until one of us is the decisive victor, I struggle with the reality of it all. I have to trust a panel of test results that unequivocally, pathologically, and painfully say that I have acute myeloid leukemia even though I really have had no symptoms to speak of. Yet the facts point to a certain, untimely demise had I continued to live as if nothing were wrong. Hey, denial will only get you so far. Damn! So, I try to face it head on…but how do you process something you couldn’t see, feel, taste, hear, or smell? Highly experienced doctors and nurses all told me that the amount of blast cells in my marrow should have debilitated me, yet I was leading a very full life: working a job I really like, skiing black diamond slopes and hitting the gym every night. It didn’t make sense. And while I still can’t reconcile it at all, I’m not letting the lack of tangible evidence dictate my course. After all, my attending physician told me that my latest marrow biopsy was clear of cancer, but had something in it that indicated that left untreated, the leukemia would return and it would possibly be unresponsive to additional rounds of chemo.

The transplant is something I need in order to survive.

It’s easy to be a bit glib about being a survivor when there isn’t any discomfort, when there isn’t a tumor to be surgically excised or radiated, but it doesn’t change one iota the fact that without definitive, aggressive treatment, survival becomes increasingly unlikely. During the wee hours of the night, during my early hours in the morning before I’m around anyone, during the time I’m exercising, and during my conversations with other patients in the ward, I find myself pondering my mortality and profoundly grateful for each additional day. As my grandpa used to say, “Each day is a bonus.” He obviously said that as a way of recognizing his own morality and that his life was coming to a close. From everything I’ve been told and from everyone I’ve spoken with, it’s rather unlikely that my time is drawing nigh, as it were, but I still find myself with that same attitude: whether I have a few months or a few decades remaining in my life, every day is a bonus.

 

I don’t know when it was over the course of the past six months since my diagnosis that I found some peace with my mortality, with the possibility that I might not survive, but I did. There’s no fear or regret, but certainly a desire for more time to make a difference somewhere, somehow, in the lives of someone else perhaps – lots of someone elses. I’m sure that’s why I enjoy the charity bicycle ride events so much. But if, on the outside chance, that’s doesn’t happen, I’ll know I lived a wonderful and rich life. I’ve realized my childhood dream of being a pilot, I saw my children come into their own adulthood, and I knew what it was to “love and be loved in return.” I could list off a number of accomplishments, places I’ve seen, fun and off-the-wall things I got to do, but in the end, what matters most is the relationships I’ve had over the course of my life. Some of them, I got right and others were, shall we say, teachable moments, for this incorrigible big kid.

And maybe it’s now that I face death that I can say with some degree of certainty that I can live even more fully, both in the moment and out a few years. I’ll still look forward to learning from my mistakes, but the fact that I’m making them will reinforce that I’m alive and moving forward. No, I’m far from ready to be tossing in the towel, but I do want to make good on a vow I made to myself when I walked through my last big crisis. As I tried to reinvent myself, I came to the unavoidable conclusion that the woulda coulda shoulda game gets me nowhere but an invitation to other people’s pity parties and I tell you, I’m not going nor am I hosting one for myself. I vowed that I would live my life without regrets, that I would tell those I loved how I felt about them and that I would be happy in spite of my circumstances. I think I’ve done pretty well with that resolution and it has stood me well. That is, by the way, one of the reasons I end my blog posts the way I do. Regardless of how long I live, I want the last words you hear from me to be those of well wishes and kindness.

I don’t need to tell you that this story isn’t over. I have learned a lot of painful life lessons even in the past five months and those lessons will be refined a bit more over the immediate future as I walk through the proverbial valley of the shadow of death. I’ll get to see some pain and suffering, some tears, and some days that will just plain suck just because, but there are things left for me to do. I don’t have the faintest idea what they are, but I know I’m going to be busy for years to come.

I hope you’ll continue to stay alongside me for the ride. It’s going to be exciting, a little awkward and hard to watch at times, but exciting nonetheless. So be well, stay strong for me, and know that there is much love sent your way…every day.

Today's music comes from the opening of the movie Moulin Rouge, a variation of Nat King Cole's Nature Boy because "...the greatest thing you'll ever learn is to love and be loved in return."

There was a boy
A very strange, enchanted boy
They say he wandered very far, very far
Over land and sea

A little shy
And sad of eye
But very wise
Was he

And then one day
The magic day he passed my way
And while we spoke of many things
Fools and kings
This he said to me

"The greatest thing
You'll ever learn
Is just to love
And be loved
In return."

Detours

Thanks to the phenomenon that is ‘chemo brain,’ I have resorted to sticky notes.  I have them all over my desk – my next grocery list, things I need around the house, and a list of topics on which I want to write, among others.  I use the lined sticky notes because my handwriting gets worse in proportion to my blood chemistry.  How many of you can say that? Then again, how many of you keep such close track of the little numbers? When I get one of those ‘eureka’ moments, I write down the gist of my idea and repost the sticky on the hutch next to my computer monitor. I actually have five topics, which is unusual. I’ve typically been staring at the ceiling at 3:00 am or watching the wall late at night hoping that inspiration will jump out of the paint and seduce me like some ethereal muse. Suffice it to say, I had planned on sitting down and fleshing out the ideas after dinner tonight before turning my brain off with a TV series on Netflix (I loathe commercials, so Netflix is my chosen alpha wave inhibitor … except at the Super Bowl, then it’s the only part of the program I watch. Go figure!).

I had arrived home after some physical therapy and a routine blood test and had finished writing out a paragraph of one of those five topics when to my annoyance, I got a call from the hospital asking me to come back right away because my platelet count was now low enough for me to require an immediate transfusion. One of the side effects of both leukemia and chemotherapy is that platelet count drops precipitously. That’s a problem because platelets keep you from bleeding to death. Normal platelet counts vary from 150,000 to 450,000 per μL. My count was just under 6,000. Sigh…OK, let me finish my lunch and I’ll come back. Another needle stick in the lab to ‘type and screen’ my blood (fourth time doing this) and then an IV in the AMU (ambulatory or outpatient ward) and another enjoyable time looking at the four walls searching for inspiration. They also made an appointment for me to come back the following day for whole blood and do this all over again, minus the ‘type and screen.’ From the time the blood products arrive, irradiated, platelets take about an hour; blood takes up to six hours. It can happen faster, but I didn’t have my PICC line in and that’s quite all right! On the plus side, every time I come back to the VA, it’s like Cheers. Everybody knows my name. I even get to choose my phlebotomist more often than not. Then again, all of these people are really well-practiced and I barely feel it…but hey, Walter is the man! Face it, we have our favorites. How many of you have favorite phlebotomists? Anyone? Yeah, didn't think so.

The outpatient rooms are set up with recliners or a couple of beds.  I figure if I’m going to be there, I want the bed in case I get sleepy, which is often these days. Since most people are in and out, they typically choose the recliners. Taking a bed, I don’t have to be exposed to someone else’s TV selection and I can read in quiet or just listen to music with my headphones with the lights out. Let’s make this as pleasant as possible! When I returned for my blood transfusion on Tuesday morning at 7:00, I got my blood chemistry and count at the lab and then up on the ward, got the same room; I took the bed closest to the window again and began the waiting game. About 10:30, they began the transfusion and by that time, one other patient had gotten his dose of chemo and a second was getting hooked up. I dozed a while and was awakened when the privacy curtain between the two beds was drawn. They brought me a lunch tray, so I took my headphones off and noshed a little.  I had been feeling a little tired because of the anemia of this stage of the chemo cycle and didn’t feel like eating all of it, so I put the tray back and read a while. It was at this point that the privacy curtain was anything but private and the conversation was one that I couldn’t avoid, no matter how I tried.

I assume it was a social worker rather than a doctor because no medical terms were used, yet this was the conversation I’d heard about. NPR’s Talk of the Nation.  The advertisement about conversations with patients about death on my local station, KUER, (shameless plug to my member station!) caught my attention, but I was a bit reticent to listen to it...yet, like a train wreck, I had to and now I was actually hearing one of those conversations through the curtain, dealing with quality of life issues, determining whether the side effects of the chemo were worth it, when to have hospice come to his home and when to begin palliative care. It was a very sobering conversation, to be sure, but the thing I noted from the person who was giving information, there was never anything that was less than hopeful and positive. I was impressed not only with the conversation, but in that I was even more at peace with and even hopeful about his and my own mortality both.

To illustrate these difficult decisions, my dad tells me a story of two friends he had known since childhood -brothers who, a few years back, received the identical diagnosis of terminal esophageal cancer, both given the same prognosis of six months to live. One elected to cash out his retirement and live out the rest of his life, doing what he had always wanted and spending time with loved ones. He died almost exactly six months to the day; the other fought the cancer to the bitter end with chemo, radiation, and surgery. The second, whom I remember as a young boy (pictured above with me as a 3 year-old), received his diagnosis just before his brother's death and won only three additional months, but spent a lot of that time in a hospital bed.

I also found out that I’m among a number of people who use a blog to get how we’re feeling out on the table, to talk about (and I’m paraphrasing, but it’s so accurate in my own story) trauma of painful exams and the nasty side effects of chemo, anxiety, funny and raw photos, and the love for our caretakers and admiration for medical professionals (Here’s the story from NPR – Why Patients Should Blog About Illness and Death ). It should come as no surprise that with the events this week my attention has been drawn to the full spectrum of life – from the day-to-day quality of life to its end.

There are lot of directions life takes us, and often it takes us on a wild detour that we couldn’t possibly foresee.  I sure didn’t anticipate the fork in the road that took me down the Leukemia Interstate Highway, but I’m cruising in the middle lane on a destination that I know will take me through Seattle.  Much beyond that, I don’t know. I get to spend a lot of time with people that I wouldn’t otherwise and meet still more incredible folks that would not be part of my circle. While it’s not fun spending as much time in the hospital as I do –both in and outpatient-it truly is like Cheers. Everyone knows me and they smile when I come in and it makes it that much easier to go through it all. I’m finding that a lot of people I didn’t know were friends have come forward and been present when I needed someone to just be there and hold my hand and others who have just faded away; and I’ve found just how very fortunate I am to have the extended family I do, and so much of it local! I wish I didn’t have to come to see everyone’s true colors and so vividly through the tears of leukemia, but…it’s what I have. Take a look-see at the people around you and see who just needs you to be there. Don’t wait for something catastrophic. What’s the worst thing that could happen? You get detoured off on some tangent and cement a really good friendship in the process.

Be well, stay strong, and much love to every last one of you!

Today’s music from Nickelback – If Today Was Your Last Day

My best friend gave me the best advice
He said each day's a gift and not a given right
Leave no stone unturned, leave your fears behind
And try to take the path less traveled by
That first step you take is the longest stride

If today was your last day and tomorrow was too late
Could you say goodbye to yesterday?
Would you live each moment like your last
Leave old pictures in the past?
Donate every dime you had, if today was your last day?
What if, what if, if today was your last day?

Against the grain should be a way of life
What's worth the price is always worth the fight
Every second counts 'cause there's no second try
So live like you're never living twice
Don't take the free ride in your own life

If today was your last day and tomorrow was too late
Could you say goodbye to yesterday?
Would you live each moment like your last?
Leave old pictures in the past?
Donate every dime you had?

And would you call those friends you never see?
Reminisce old memories?
Would you forgive your enemies?
And would you find that one you're dreaming of?
Swear up and down to God above
That you'd finally fall in love if today was your last day?

If today was your last day
Would you make your mark by mending a broken heart?
You know it's never too late to shoot for the stars
Regardless of who you are
So do whatever it takes
'Cause you can't rewind a moment in this life
Let nothing stand in your way
'Cause the hands of time are never on your side

If today was your last day and tomorrow was too late
Could you say goodbye to yesterday?
Would you live each moment like your last?
Leave old pictures in the past?
Donate every dime you had?

And would you call those friends you never see?
Reminisce old memories?
Would you forgive your enemies?
And would you find that one you're dreaming of
Swear up and down to God above
That you'd finally fall in love if today was your last day?

Transitions

I find my writing often skirts territory bounded by being a bit didactic and preachy on one side and TMI (too much information) on the other. Some of the things you think about from a hospital bed or even in your own bed if you’re pondering the joys of cancer may come across as a bit pretentious or pompous if not approached with the right balance of sobriety and sincerity; and navigating to that point may include material that could be considered icky, immodest, or downright inappropriate if not handled well. Such has been my challenge in presenting the day-to-day things I experience physically and work through mentally and emotionally. The biggest battleground for me has been in the mind with this thing called cancer.

Sure, I’ve had some bouts of feeling really lousy. There has been quite a bit of discomfort related to my treatment. There have been the headaches resulting from the stab-me-in-the-back (aka intrathecal) chemotherapy and spinal taps; there is the anemia that has caused a number of really inconvenient things, and the chemo sometimes just makes me feel really awful. In fact, during my first hospitalization, the induction chemo made me feel worse than I ever have felt in my life. Waking up seeing my mom dressed in a yellow paper gown at the foot of my bed and me barely able to register her being there is something I wouldn't wish on anyone. Of course, the alternative of not waking up at all doesn’t excite me too terribly much!

Today, one of those physical things was a bit embarrassing, if not a bit funny (you have to be able to laugh at yourself) as I dropped my car off for some routine maintenance.  I was walking out to meet my mom who was giving me a ride up to the hospital. I had my laptop and my gym bags both slung over my shoulder and carrying a cup of coffee in a cardboard drink holder. The wind blew a napkin from the tray and as I stooped down to pick up the napkin off the ground, the weight of the bags pulled me over backward and I landed flat on my posterior...I saved the drink for my mom (good son that I am!) but my weakened legs were unable to lift me back upright with the added weight. That’s hard for someone who pressed 300 pounds just weeks ago and cycled over 500 miles last June. But that’s reality right now.

Jim installing my PICC line. Not a real
pleasant procedure, but it's not bad either.
A little bloody as you can see.

Today marked the beginning of my second 28-day cycle. I begin another round of consolidation chemotherapy in the morning. To save me from becoming a human voodoo doll this week, I had my PICC line re-installed today. This time around, I saw the 3” needle that went into the vein as well as the ultrasound. Since my veins have gotten smaller, it’s not a really pleasant feeling. I understand that while in Seattle, I’ll need something called a Hickman port.  It is different from the PICC line that is in my arm as a Hickman port is surgically implanted in my chest, but essentially does the same thing as a PICC line. It allows the same function as an IV as well as blood withdrawal for testing. From what I can see in pictures, it allows me to flush it myself whereas the PICC line is in my arm and makes it pretty much impossible. It’s a bit uncomfortable tonight, but I much prefer that to getting stuck at least eight times (for labs and assuming that they’d leave an IV in for at least the day), not including the misses that inevitably happen.

On the plus side, after being here as much as I have, it was like homecoming week and I got the best room in the house. What’s just a little disconcerting though, is that the room I have is the room set aside for hospice care. It has a couple of things other rooms don’t have like a lot of chairs ostensibly for family. I have a lot of visitors stopping by, so that’s a good thing.  It also has a little microwave and a fridge like an extended stay. I guess that’s a good thing though in that I’ve never seen the room used and there are a number of beds open in the acute care area, meaning not a lot of people are seriously ill…and no one on their way toward checking out permanently.

And as I’ve said, I have no plans on checking out. But who plans on that sort of thing? Ah, the estate planning lawyers are slapping their palms on their foreheads and exclaiming, “Exactly!” about now, aren’t they? I did put together an Advance Planning Directive when I arrived for my first stay at the local franchise of the lovely Hotel California and as I spent the weekend doing a lot of spring cleaning, I realized I felt the need to have my affairs in order. During our weekly family coffee klatch, I was once again reminded pretty explicitly about exactly that.

No one should mistake responsible planning for a lack of hope, because in reality, it’s more likely that I get taken out by a distracted driver who is focused more on the text message that just arrived than me on my bicycle or crossing the road on foot.  That inch difference on the steering wheel could be enough to create one of those Newtonian physics problems where two physical objects don’t occupy the same place at the same time. I don’t have a lot of material possessions nor do I have any real assets where there would be one of those dramatic readings by some lawyer. Rather, making a few decisions now makes it far easier on those we leave behind. For example, I am an organ donor and I’d like to leave my mortal remains to the University of Utah to train doctors.  After all, I’m not using the body any longer. I’ve made that much clear to my family.  As for the details like who gets my personal possessions, I need to write that out. And the thing that got me thinking over the weekend is what happens to our on-line presence when we pass on? Unless we have someone take charge of that, it just stays there and becomes the property of some faceless person who doesn’t care. Something to take control of, to be sure.

So my public service announcement of the day is to have a plan for your passing. It’s not morbid, but rather the greatest act of consideration and love to those you leave behind. And it’s peace of mind for you. My battleground is not so much with death and dying even though that is certainly part of my thought process for obvious reasons, but the getting from here to there. Because my doctor is now maintaining me at remission so that I can be ready for the transplant, my mind wanders to the next stage in the treatment: the actual transplant.  While the technical side of that is pretty well understood, in that it's in another state with a different medical staff than I've grown accustomed to, and the literature I've read from that VA hospital is rather impersonal (bordering on strict), it has been intimidating. I recognize that there are a lot of things that will be cleared up once I arrive and there will be a whole lot more positive than negative once I've gotten acquainted with the people and the process. Until then, it's hard to keep the mind reined in.

The big clock on the wall says it's time to turn in, so enough for tonight.

Music for the day - "Sleep" by Eric Whitacre.  If you've never seen the YouTube videos of Eric Whitacre, they're fascinating.  They're combinations of hundreds of individuals who contribute on-line.  If you liked this, the one that is absolutely haunting is Lux Aurumque

Be well, stay strong, and much love to you all.