Yeah — and Another Thing!

Shortly after sign-in here at the Lied Center I was given my personal incentive spirometer. It looks like a Fisher-Price version of something Jacques Cousteau could have invented. Simple, but dangerous. It’s about the size of a jumbo, thermo coffee mug but has two chamber, narrow and wide. You don’t sip out of the top — I’ll get to that.

It has two moving parts. One is a yellow bobble valve that jumps up and down out of its seat inside the narrow vertical chamber and the other is a white disk that rides up and down in the wide chamber. You could also count the yellow slider that indicates a volume by pointing at a number on a scale, which is printed on the larger chamber. The engineering is basic: cylinders and hemispheres. The whole thing could have been designed with a compass and a ruler in a few minutes. The Cousteau theme is rounded off by the bendy, ribbed air hose and a white, nylon mouthpiece.

The idea is really complicated. You exhale and then you stick the mouthpiece in your mouth and inhale, but very slowly, keeping the bobble valve at a sleepy jiggle rather than an excited hop. You’re drawing air out of the larger cylinder above the white disk; there’s an inlet at the bottom of the cylinder so the disk rises. (Yes, you’re sucking it up.)

What’s going on here? We’re taking a deep breath.

Deep breaths are good because they allow your alveoli to wiggle, stretch and loosen up anything that might be sticking between them. Who can argue with that? But, having a fetish with divine or supernatural power while I take deep breaths is even better. The incentive spirometer connects me to a community of experts and remains stubbornly in my visual field, reminding me to do the exercise. We’ve learned to love our fetishes even more if they have numbers. Mine tops out at 2,500 ml because it’s the Voldyne 2500.

Today, I was wearing the red toque that my friend Mylo gave me when I left Vancouver. My brother David told me that I reminded him of Jacques Cousteau.

Here in Nebraska they know how to skooch and they can’t figure out why you don’t skooch too. But they’re happy to show you how. Skooching is vital to the medical enterprise. You can hardly sit down around here without needing to skooch. For example, skooching is an integral part of the chest X-Ray experience — without it you’d have a hard time getting yourself into that flat chicken posture that X-Ray technicians love see. Anything that’s liable to hurt, because it’s going to pierce your flesh someplace where thousands of nerve endings have congregated in rapt anticipation, is announced as a “skooch”, as in “We’ll just — umph! — skooch this in here,” the speaker’s easy grammatical shift making you a co-conspirator so that no blame can apply.

“Just skooch a bit for me. Thanks.”

What had I done? It was a small movement that hardly seemed to have put anything anywhere where it wasn’t already: a kind of effort with almost nugatory result which seems more a gesture of good will and cooperation than an attempt at displacement. Yet, it seems to spread happiness. Unlike hospital workers I have met elsewhere, who reserve displays of mere contentment for occasions such as lottery winnings, here in Omaha, a mere skooch brings a ready smile.

This is the face of chemotherapy. I know, there’s something a little rigid, even relentless, about her, but beneath her plastic bags of toxic chemicals, she’s all good intentions. She has a thoughtful side. I’ve noticed her staring out at the Omaha hills wondering, I’m sure, whether there are others out there she can get her drip into.

But there are friends and colleagues to see right here in the hospital. Down to the third.

“Thank goodness there aren’t any geezers on-board.

I’ve waited I don’t know how long for some fat old farmer to get his tractor over the gap. I thought I was going to have to ring the dinner bell.

“And that! Don’t ask me what that’s doing in a cancer ward. Check with the NEA, why don’t you? It’s Art, I’m told, but I’m from a family of engineers and more than that, I find staring at a man’s breasts in public frankly uncomfortable. In private too if you need to ask. Gives nursing a bad name. Now this Art I can stop and look at. Those haystacks look like haystacks because the are haystacks and what’s wrong with that?

“I’d rather avoid him completely but he’s actually a distant cousin. And not looking well since he put on all that weight. The receptionist is fixated on bugs.

There’s another one going round she tells me. Half the time I think she makes them up.

“More Art. Jonathan! But he’s 72 years old! Will that man ever learn to draw?

Sure Linda and Susan are nice, but if you want to get anything done you have to just push right in there. ‘Has pharma sent my chemo yet?’”

There are several ways of getting juice through the skin of a cancer patient. I have two. The Power Port above my right breast lies under the skin. It looks like a pitcher’s mound, but with three subtle bumps. A buried pipeline runs from the mound and is visible in an arc toward my sternum before it disappears. The Power Port and I have been together now for four or five chemotherapy treatments. The nurses like it. I figure I can live with it.

My new one, as of today, is a Peripherally Inserted Central Catheter. The staff call these and similar devices “central lines”. The PICC is a tube that goes through my skin in the fold of my elbow, Yes, there’s a real hole, but it’s normally covered with a plastic, sticky dressing. Installing the PICC should be as easy as running a new phone line in an old house. But complications do arise. In my case, some minor defect in the nozzle made it impossible to shove the plastic tube more than an inch or so beyond the entry point. I didn’t mention that the tube is supposed to go from your elbow, up you arm, across your shoulder and into your Superior Vena Cava — that’s one of the big re-entry points of your heart. To keep the tube stiff for this 52-centimeter trip, there’s a piece of wire inside it that gets pulled out near the last step.

So Linda opened another kit while blood ran down my arm. These bits of hardware are supplied to the hospital in kits that include the tools needed to do the installation, various paper protective sheets, and probably a set of instructions in English and Spanish. After watching four times, I think I could do it.

The second try looked good, until the X-ray showed that we were on the right street, but hadn’t pulled far enough ahead. Back upstairs where Linda was joined for the third attempt by Cathy, who can sing “Beautiful Dreamer” all the way through — it helps loosen up the vein — and Rob who is learning how to do this stuff.

Attempt three hit a reluctant vein. That tube just wasn’t going anywhere. It took another excavation in a new vein with some fierce concentration to reach all the way to the Superior Vena Cava. We declared victory, and glued down the dressing. Now I’ve got two handy little garden hose fittings ready for whatever needs to go in or out. The next generation of these will almost certainly include fiber-optic cable.

Both of my brothers, Don and David, were a perfect match — six alleles out of six — which is pretty rare odds. David has his hands full, looking after his son Owen who has childhood leukemia. (Owen is doing fine in his second year of treatment.) So Don’s schedule was a little easier to manage. He flew from Toronto and has been here in Omaha since last Sunday while they tested and administered a “growth factor” to encourage peak production of stem cells.

This Monday morning was the crucial day. They set him up in a Lazy-Boy chair lined with pillows and got needles into both arms at the fold of the elbows. Then they hooked up the tubes and began circulating his blood through the apheresis machine. By centrifuging the blood, they can separate its components by weight. They put back the plasma and the red cells, but send the white cells on a further detour where stem cells are extracted before the rest of the white cells are returned. They do that for about three and a half hours, watching the pressure on both arms. It tingled a little, he said, so they gave him Tums to boost his calcium.

Later in the afternoon, we learned that they got the primo blend — 4.5 million — the highest octane rating!

Stem cells are the ones that can become any type of cell that you need. The plan is that when they are injected into me, they will replace my errant T-Cells. I get a new — or at least renovated — immune system. Don gets a trip to Omaha in February.

Atlantic Magazine, in its March, 2008 issue, tells us that in the year 1981, 12.6 per cent of American working women were overweight or obese. In 2000 the comparative number was 50.4. Since then the number seems to have risen. Men follow a very similar trend.

Naturally, just as the family car has grown into the family truck, the wheelchair has had to make accommodations too. Don insisted on this souvenir shot. He’s six-foot one and weighs 200 pounds.

Don has been reading about the Bay of Pigs, the badly bungled attempt by the CIA to invade Cuba and overthrow Fidel Castro’s government in 1961. The CIA were confident in Cuba because they had succeeded in Iran eight years early, overthrowing an elected government under President Mohammed Mossadegh.

Mossadegh, too few remember, was determined to retrieve Iranian oil resources after they had been stolen by the British under the name “Anglo-Iranian Oil Company” — which is now known as “BP”. You might want a yellow highlighter for that one. The defeat of the Iranian electorate led very quickly to the dictatorship of the Shah of Iran, followed by the ascendancy of Ruhollah Musawi Khomeini, then the Iranian war with Iraq, the Iraqi invasion of Kuwait, the U.S. retaliation, and then the current second-most costly war in in U.S. history, the U.S. Invasion of Iraq.

The Cuban adventure was more successful in the sense that the invaders were beaten back and sent home. The main repercussion was executive embarrassment. Maybe that negatively affected the Cuban Missile Crisis — hard to know — but the long-term effect seems to be that the United States spent the next 41 years looking for a Bay of Pigs encore before finding one in Guantanamo Bay. Such a great stretch of beach to imprison prisoners from a war who are not really prisoners of war.

Why am I thinking about this now? Because we are planning our own invasion, Don and I. On Monday next week an invading force of Don’s stem cells — in top fighting form — will cross the breach and begin fighting their way to my bone marrow. Satellite sensors are not one hundred per cent accurate, but we will know, within days, whether the new invading cells have routed the old. Of course, they will be aided in their ground operations by five days of supporting cover — strategic chemical warfare administered with pin-point precision so as to protect our allies while maximizing the destruction of the enemy’s transportation and energy assets — specifically my ability to walk and stay awake.

If the invasion succeeds, there will be a period of mopping up in which the new cells expropriate the traditional habitats of the old cells, convert the few remaining hold-outs to the new way of life by shining example, establish a legal system based on cell-rights, and introduce cheap sports coverage on satellite TV.

Even during the Cold War, the Soviet Union was exporting titanium to the United States. A large part of the production was being used to build Blackbirds which would later fly spy missions over the Soviets and the rest of us. The Blackbird SR-71 also tried out some early stealth engineering, based on the work of Soviet scientist Pyotr Ya. Ufimtsev who later moved to UCLA.

See! We can all get along!

There are retired Blackbirds in several air museums around the States. This particular one is in the Strategic Air and Space Museum, near Omaha, Nebraska. While the SR-71 is still the fastest airplane in the world — New York to London in an hour and 55 minutes — it’s just for looking. That is, it won’t drop anything on you. The rest of the museum is known locally as the “SAC” or “Strategic Air Command” museum and is more interested in the Cold War business of getting heavy bombs a few thousand feet over your backyard.

Rocket success finally brought an end to all this toy-town technology. The wetware was soon waiting on the ground while ICBMs stood silently, ready to do the heavy lifting and the satellites took the pictures. The dual-station computer consoles that controlled the missiles aren’t interesting enough to feature in the museum. There are a couple of them pushed against a wall in the hangar and they look like something you might have used to send a message to your branch plant before you installed your first PBX. Whatever has replaced these old consoles is still buried deep in the Nebraska dirt ready to be part of the argument. The message, of course, will be the same as ever.

What are the chances of success? You can look at it this way and then look at it that way, but in the end it boils down to about 50/50.

If we knew as much about lymphoma as we know about salt and pepper we’d have another angle on it. After all, how often does anyone choose pepper and salt? These two, and the NutraSweet are on display at the Josyln Museum of Art. So were two very big Chihuly glass sculptures overhead — I spared you those.

The Josyln also has extensive galleries of Native American art. You don’t have to stand in front of a picture of people huddling for warmth, while the western prairie winds and snow howl outside, to know that 50/50 is good odds.

People ask, “How are you”, and they expect more than the usual “Fine. How are you?” What they’re really asking is, “What the hell is lymphoma like?”

If you can describe a complex problem really well, you’ve probably already fixed it. So this should be read as illustrative: I feel like a newt.

We used to scoop newts out of the muddy ponds in the ravine near where I lived in Toronto. They looked chilly and they felt wiggly. I am chilly because, like a newt, I have no hair. No, not anywhere. I’m often wiggly because my feet get numb and tingly and have to be wiggled back to the way feet should be.

But mostly I am like a newt because I am spotted. Lymphoma has changed my skin tone from average-white-guy beigey-pink to well-tanned-but-disconcertingly gray. And not evenly. Over time, the pattern seems to dissolve, but in patches, leaving me newt-like. If you were doing an opera staged in a muddy pond, I would be a shoo-in for the ensemble, despite my voice. Well, maybe my voice is newt-like too.