Tuesday, March 3, 2015

Turning the page

  It was not unexpected.  I told my doctor 2 months ago that something was happening down in my liver region.  The body knows.

Doctors are pretty easy to read too.  When Dr. Krajewski came into the room he said, “Well let’s start with the labs”, implying that good news would be first.  But he did get around to the results of the scans and they revealed what I had expected.  The regimen of chemotherapy that I have been on for nearly a year was no longer working.  The primary tumor on the liver was nearly double in size since the last scan in November.  And there was some other evidence of “worsening metastases” in that region and around the abdomen.

The thing about chemo when you are employing palliative therapy is that you keep trying new drugs until they no longer work.  Dr. K had a list of the stuff that was know to be effective on my kind of cancer and he had crossed off all the drugs that I had burned through over the 3 years.  There were still a few left and he was recommending an old drug, Paclitaxel, along with a new (approved just last year) companion drug called Ramucirumab.  Because of the newness and some the side effects of the latter, he recommended that I get a second opinion from the University of Michigan Hospital who would have more experience with patients on this drug.

So we are going to start next week with Paclitaxel and if the geniuses at U of M think it is right for me, we’ll add the Ramucirumab in about 3 weeks.

I’ve really liked that previous regimen because the side effects were so tolerable.  There is no telling which of the side effects will come into play with the new drugs but it looks like losing my hair is a common one.  I can live with that.  I just hope it does not affect the taste of food.  I would be sad to lose that again.

As I said, it was not unexpected so I am not at all devastated.  I am grateful that I still look healthy and feel pretty damn good.  I am also in no hurry for the spring or disappointed in cold temperatures.  It is all good and the warm sunny days will come, regardless.

Monday, March 2, 2015

3 years

When I woke up this morning I got to thinking that it was March already.  I knew that it was sometime in March 2012 when I initially got the call from Dr. Lown that the biopsy from my upper endoscopy had come back positive for esophageal cancer.  I just looked back at my calendar and it was March 2 of that year when I received that call.  So as of today it has been 3 years.

Stage 4 esophageal cancer has a reputation for killing people fast.  Hardly anyone with this diagnosis lasts 5 years.  Most don’t last even 1 year.  I am incredibly grateful that I have reached this milestone and still feel very much alive. My body has served me well.

One of my favorite stories (that I probably have already told in this blog somewhere) is how a simple screw-up in an early medical procedure saved or at least extended my life.

When I was first diagnosed as having the adenocarcinoma cells in my esophagus near the junction of my stomach, there was initial concern regarding staging, as early stages are survivable. Unfortunately, most cases are discovered late because by the time you typically experience symptoms, the disease has already spread. Still, there was hope that we had discovered it in an early stage.  A CT/PET scan would tell the story.

After the scan, I received the bad news that there were hot spots in both my liver and in the center of my chest, in the mediastinum area. This could indicate stage 4.  But to be sure that these hot spots were cancer, they would need to be biopsied.  The liver biopsy was done first since it was relative easy to get to… just a poke through soft tissue.  I was told that if that biopsy revealed esophageal cancer cells, that that would indicate metastases and I would be considered stage 4 and they would not bother to biopsy the spot in my chest, as that would require a thoracic surgery and there was no point to put me through that because it would not change my diagnosis.

Well that liver biopsy came back negative for cancer and the thoracic surgery, using the minimally invasive daVinci robot, was scheduled.  The doctor was hopeful that the hot spot in my chest would also be negative for esophageal cancer as that would indicate a lower stage cancer and I would be a candidate for esophagectomy; a major surgery but also the gold standard for surviving this disease.  They would not perform an esophagectomy on a stage 4 patient because it was considered too invasive to put someone through who had perhaps only months to live anyway.

So it was a weird mixed blessing when the results of the thoracic biopsy came back negative for esophageal cancer but positive for a particularly aggressive strain of non-Hodgkins lymphoma.  The good news being that the lymphoma was deadly but curable through chemotherapy and stem cell transplant, and the lack of adenocarcinoma cells meant that my esophageal cancer had not metastasized, meaning I was early stage for that cancer, and was therefore operable.  I had the operation to remove my esophagus days later and a plan was set in place to put me through the chemo to kill any lymphoma left in my body.

But then the other shoe dropped.  The guy who had done the liver biopsy was looking back at reports and decided that he was not 100% sure that the biopsy he had done had actually sampled the concerning spot.  He asked to repeat the liver biopsy.  This was done and this time it came back positive for esophageal cancer.  I was now considered stage 4.

Bad news, right?  But here’s the thing that occurred to me later.  If that first biopsy had not been screwed up and had come back positive, they would not have gone in to test that spot in my chest.  They would never have discovered the fast-growing, deadly lymphoma there and untreated, it would have quickly killed me.  As it turned out, the doctor was able to cut out the entire lymph node with wide margins during that daVinci surgery and evidently he got it all, as it has not returned.  I received the life extending esophagectomy and because of the eventual stage 4 prognosis I was not put through the grueling stem cell transplant rigmarole to cure the lymphoma.  And here I am 3 years later, having a life beyond expectation.

Tomorrow I get the results of last Friday’s quarterly CT scan.  We’ll see if my weird luck continues.

Friday, February 27, 2015

Warm Respite



While Michigan was experiencing bone-chilling cold February temperatures, Mary and I took 9 days to bring some of that cold down to the Sunshine State.  We had a great time visiting my Mom & Dad, who are staying in Clearwater, Florida for a chunk of time, and also Mary’s brother Matt and his wife Karen who live in Bradenton, Florida, about an hour away.  Some of those days were sunny and warm but all days were filled with great company and good food.  And the beach is beautiful even on a chilly day.

We flew in on Allegiant Airlines, a discount airline that charges for amenities like carry-on baggage, choosing your own seat, beverage service, and even using a credit card on their website.  They don’t have a First Class section and one surprise benefit of that is that fellow travelers seemed generally nicer. Flying no frills on the cheap is a common value. No one was pushing to get ahead in the boarding line, there was plenty of space in the overhead compartments and no one seemed grumpy about little inconveniences.  The St. Petersburg/Clearwater airport was small and easy to navigate and we were greeted by the smiling faces of Mom and Dad who were parked right in front of the terminal.

They were renting a doublewide mobile home at a nearby mobile home park where Mary and I had our own bedroom and bathroom.  It was not a particularly beautiful neighborhood... lots of nearby traffic and strip malls... but there were plenty of palm trees and lush gardens that made us feel like we were in Florida.  I was surprised at how quickly it felt like we had jumped right from winter to an illusion of spring.

In the morning, I joined Dad on his routine walk to get a newspaper from the machine in front of a chain restaurant around the corner.  Mom reads them and does the crosswords but Dad does the legwork.

We decided to spend the day at nearby Honeymoon Island StatePark. They have a beautiful beach and a great Nature Center with an awesome hiking trail where you will see dozen’s of Osprey nesting and flying around talking to each other.  There was a bonus Bald Eagle’s nest at the end of the trail where we saw two hatchlings and a parent eagle.  We also ran into a couple of armadillos who seem quite oblivious to having people around them.  I’d never seen an armadillo before so it was a treat to see them up close and try to figure out if they were mammals, reptiles or possibly dinosaurs.
Birdwatching

Chip off the old block

Beachside lunch

The old man and the sea

Mary

Osprey Hike

What is this creature?


The next day Mom and Dad drove us down to Bradenton where we were greeted by Matt and Karen at their home.  We all dined together for lunch before bidding adieu to the folks.  Matt, Karen, Mary and I hung out in the lush back yard and discussed plans for our next 4 days.  We had splurged on a near-beach, 2-bedroom apartment rental on Anna Maria Island to celebrate Mary and my 8-year Anniversary and Matt and Karen’s “honeymoon” as they had just legally tied the knot the week before; a mere civil rubber stamp to augment their commitment ceremony marriage from years ago.  The “Key Lime Cottage” was large and lovely with a big and well-appointed kitchen, although we had to walk across a busy road to get to the private beach.

There were may highlights to our days on Anna Maria Island, including a wonderful celebratory dinner at Sign of the Mermaid restaurant, Karen’s fantastic cooking, beach wandering, meeting up with Blake, Brie, and Kimber (nephew and nieces), nature hiking, birdwatching, napping and general beneficial laziness.  I’ll let the pictures do the talking.

Happy Anniversary- 8 years!

We will eat you!

Photo standoff

Beach entrance

The balcony of the Key Lime Cottage

Balcony up close

Dinner at the "Sign of the Mermaid"

siblings

Lots of room on this beach

Matt & Karen bundled up for sunset view

Yeah, we were there too.

Obligatory selfie



Brie and Blake

Back at Matt & Karen's

Karen whipped up a batch of fresh lemonade. Rum optional.
Matt and Karen delivered us back to Clearwater for the vacation end cap with my folks.  We all had a terrific Vietnamese dinner together before Matt and Karen said goodbye. Mom, Dad, Mary and I watched the Academy Awards together that night. 

The next day was very foggy but we decided it would be a perfect day to try out the very popular Clearwater Beach.  On a nice day you have to get up pretty early to avoid the gridlock traffic of beach-goers.  It was a relaxing day and after lunch we went to the Clearwater Aquarium which is essentially a rehab facility for wounded dolphins, sea turtles and sea otters.  Its claim to fame is being the setting for the Disney movie, "Dolphin’s Tale” and much of their displays had to do with celebrating that movie.  Since none of us had seen it, it was pretty much lost on us but we did see the real life tail-less dolphin “Winter” who stars in the movie.

Mom cooked another amazing dinner and we watched a PBS British baking competition show before heading for bed.

Our last day was a travel day.  Marlee was waiting for us with winter coats at the Gerald R Ford Airport in near-zero temperatures.  The house was welcoming in spite of the cold.  It is always good to be back home.

Saturday, February 7, 2015

Sidetracked to the hospital


I’m home again after an exhausting and unexpected interlude with the hospital.  Still trying to figure out that institution.  You really turn over most aspects of your life to its control.  It has many friendly faces and amenities but there is also a sense of imprisonment. 


WARNING: This post discusses body waste products.  Can you handle that?  If not, skip to lower on the page where you see ***.

It all started with a sense that I have that something is going on in my gut.  I’ve been feeling little twitches in my liver (yep, I know exactly where it resides) and wondering whether cancer is preparing to mess with me again.  I suppose anyone who has ever had cancer suppresses a fear that it could return and the littlest sign of reawakening exposes the hiding place for that fear.  My twitches had me on high alert and therefore I was focused perhaps a little too much on the output of my digestive system.  Is that blood I see or perhaps just the beets I had for dinner two nights ago?  It doesn’t really look like blood and yet it is different from what I’m used to.  I don’t really want to discuss my bowel movements with anyone. I don’t want to talk about this; not with a nurse, not with someone who picks up a phone at a doctor’s office, and not even my wife who has enough to worry about without thinking about my poop too.  I even hope you are not reading this.

Pee, on the other hand, is just slightly easier to talk about.  So when I had two days in a row of urine that was pinkish or maybe orangey, it gave me both concern and courage to call the doctor’s office to see whether that alone was enough to come in early or should I just wait until my regular doctor appointment next Tuesday.  Nurse Jackie checked with Dr. K and asked me to come in to the infusion clinic right away for blood and urine tests.  I got there about 4:00pm on Thursday.

The Lacks Center people are always so wonderful to deal with and there is rarely any kind of hassle and thus it is really a comfort zone for me despite the fact that they typically dump poisonous chemicals directly into my circulatory system.  Since I would need a direct blood draw, when I arrived I asked if Dawn was there today.  She is the best Phlebotomist I have ever encountered.  I have no fear if it is Dawn doing the arm poke.  Dawn was not there. I wondered aloud whether they could do a draw from my port but Nurse Jackie said that they would specifically be doing some clotting tests and the Heparin they use while accessing the port would contaminate the test.  Since my platelet counts have been low and platelets are the clotting agents in blood, the big worry is that there could be internal bleeding. 

So I got the poke from the other Phlebotomist, who on a previous occasion had missed the vein thrice before switching to my other arm.  This time, fortunately, she nailed it right away.  I rendered a orangeish urine sample right afterward (in the bathroom) and then sat around reading the newspaper while the lab tested the samples.

Jackie came back after a bit.  The good news was that there was no blood in the pee sample.  The redness in the urine could mean other things.  The bad news was that the hemoglobin level in my blood sample had taken a dive since the last test.  It was approaching a level where they consider a transfusion.  She asked if I could provide a stool sample.  I gulped a cup of coffee and shortly after, found I was able to oblige.  After more waiting around, the answer came back:  there was indeed blood in the sample.  Jackie said I should report to a hospital room on the fourth floor for intake.  This was not what I had in mind when I made that initial phone call.

*** I slipped into the skimpy hospital uniform and called Mary and then Marlee to let them know they were on their own for dinner and asked brave Mary to bring a few things from the house, including Marlee, so they could pick up my car from the open-air parking lot.  Extra cars can be a hassle when leaving the hospital.

The 4th Floor nurse ran through a huge list of questions, as they must do, and accessed my port for ready access to medicines, saline and blood.  She also sampled my fluids for redundant testing.  Shortly, one of Dr. K’s Physician’s Assistants showed up to help figure out what must come next. She reiterated that the dropping hemoglobin levels were concerning.  The reading from my regular chemo appointment last week had been 11.1.  The reading from the infusion clinic a couple hours ago was 8.6 and the sample that they processed minutes ago was 7.9.  If it hit 7.0, they would give me a transfusion of a couple of units of blood.  She also indicated that they would bring in an upper Gastro-Intestinal Specialist to see if a source for bleeding could be found from the top down.  If nothing could be determined from an endoscopy, then they would likely proceed to a CT Scan.

It was 6:40pm and I was hungry and remembering from before that the kitchen closes at 7:00pm, I requested a menu and ordered enough food to last me until midnight.  The nurse said no food after midnight so I would be properly fasted for a scope in the morning.  She also said I would likely be spending a second night in the hospitl to monitor the blood transfusion.

Then the waiting began.  The food arrived and then Mary and Marlee came up with my iPad and chargers.  The room staff changed. Mary and Marlee left since I was pretty settled and they had not yet eaten. More fluids were taken.  My blood type was tested (O+). I checked out the TV channels but settled on playing with QuizUp, a trivia App on my iPad where you match wits live with other players from all over the world.  I selected the category, “Name the Movie” and played until I was ranked #1 in Michigan, which is about a #238 ranking for that category worldwide.  The nurse popped in to let me know that I would be awoken at 3:00am by a new nurse for more blood tests and so I shut off all electronics and lights and slipped off to sleep easily.

I woke about 2:45am and decided to browse social media until the blood draw.

In the morning at about 7:30am I met a new nurse who reminded me “No food or water”.  She said doctors usually came around sometime in the morning.  She also told me that my particular Type O blood included a rare antibody so they needed to find a couple of pints somewhere that had that same antibodies so my cells would get along nicely with the donor cells.  She said that chemo patients occasionally develop special antibodies.  I wanted to know more about this and she told me she would try to find more info.  But good news… there had been an uptick in my hemoglobin levels. 

Eventually the GI Doc showed up to explain his plans for me.  He thought the blood loss could be coming from an ulcer or a new stomach tumor.  His endoscope could prove or disprove that.  I’ve been through dozens of endoscopies so that was no big deal.  The trouble was, his schedule was already quite full so he could not squeeze me in until sometime in the afternoon.  For me that meant no food or drink for another half day and lots more waiting around.  A different PA colleague of Dr. K came by to say Dr. K would come by after the scoping to let me know what was up.

I downloaded a new book on my iPad and read for a while.  My sister Betsy volunteers at the Lacks Center 3rd floor (on top of an incredibly busy life schedule) so she stopped by around lunchtime for a visit and conversation. My nurse popped in again to say that the hemoglobin levels were continuing to rise and they would be cancelling the transfusion. Also my pee was now a natural pale yellow.  The reddish color had probably been due to dehydration and all these IV fluids they had given me had corrected this.  Finally at about 1:45, a guy from transport showed up to wheel me to my procedure.  By 2:15 they were ready to proceed.

I’ve had better endoscopies, ones where I did not wake up gagging on an instrument in my throat, but the Versed they give you makes you forget most of the experience.  It just begins and then seemingly immediately, you are all done.  Because of the drugs, I am groggy on the rest but I do know that everything looked fine and dandy from his perspective.  I have a picture to prove it.


Back in the room, I ordered some food and waited for Dr. K.  Mary showed up and we waited together.  Finally Dr. K showed up and pretty much told me that I had managed to self-heal and that he was going to release me.  Yahoo!!  We’d continue with our regular chemo schedule and we would do a CT scan after Mary and I returned from our Florida vacation in just a few weeks.  Irrationally, I had more fear about missing this vacation than I did about the possible return of a tumor so this was really good news.

I do kind of feel better now that I am hydrated but that 24 hours in the hospital sure felt like a big, expensive waste of time just to get my pee the right color.  Once you check in, you just kind of have to ride it to the end, wherever that takes you.

Friday, January 16, 2015

In praise of chemotherapy

I love chemotherapy.  Too much? Mostly I feel this way because I am a sucker for the underdog. Poor chemotherapy has such a bad rep. It strikes fear into both those who are about to go into it and to those who merely hear about it. And those in the middle of receiving it gag at the mere thought.  There is something about dumping poison into the circulatory system that feels out of control and just wrong.

Take the recent story of Cassandra, A Connecticut teen with a curable form of deadly Lymphoma who wanted to choose no treatment.  The State wanted to force her to undergo chemotherapy treatment.  Now I have mixed feelings about this.  I don't like the State forcing its will on someone but at the same time, I'm not sure an adolescent has the maturity to make this kind of decision.  Cassandra is not fully aware of the potential for a life full of interesting possibilities.  Could a brush with toxicity really be that bad that you would forgo the potential for future love, beauty and brilliant life? Looks like the State won out in Cassandra's case and I truly hope she will come to appreciate the overreach.

As someone who has embraced chemo as a partner, it is easy to identify the much sexier alternative.  It is the story of some natural substance that has miraculously cured  the incurable.  It is an herb only found in South American jungles, a vegetarian diet or perhaps a marijuana extract.  Everyone knows someone who knows someone who was told they would die but instead they went on living due to their trust in this natural substance and their eschewing of scientific standard methods.  Boy, I would love to believe this.  Chemo is a bitch of a partner after all.  I'd much rather consume a beneficial herb, eat delicious, organic foods and get high than hook up to a toxic drip, experience nausea  and feel my hands and feet go numb.  And while the former has great second hand stories, the latter has numbers and measurable results.  Which would you choose?  I would not blame anyone for going with the dream.  My embracing chemotherapy is going with reality.  And my choice to love effective  chemotherapy helps me to see it as a battle partner.

Cancer is not like a virus or bacteria.  It is not easily recognized by my immune system as a foreigner.  It is me.  It has my DNA.  It is mutated Chuck Peterson cells that have a gift for replicating themselves.  Anything good for Chuck Peterson is probably good for my cancer cells too.  That is why it is such a difficult disease to fight.  It needs to be tricked.  It has my immune cells fooled.  They can't figure out where normal Chuck Peterson ends and where mutant Chuck Peterson begins. My body naturally gives cancer cells what they need to survive and thrive; blood supply and waste removal. Chemotherapy is the science of making mutant Chuck Peterson stand out from healthy Chuck Peterson so those cells may be identified and killed by natural or chemical processes.

How the battle is waged also depends on the stage of the cancer.  It took me a while to understand this.  Stage 1 is very localized. Stages 2 & 3 are cancers penetrating margins and reaching out to spread to other parts of the body, often using the lymph system as a highway.  Stage 4 is considered incurable as it has moved to other organs and the mutant cells are spread far and wide.  The battle is to remove every single mutant cell.  In early stages, surgery is the gold standard.  It is very direct removal of the baddies. Radiation is good for picking up stragglers in the region.  Chemo is a whole body approach that can kill off farther flung stragglers before they have enough mass to reconstitute as a tumor.  Chemo can also keep a tumor from growing larger.

The battle metaphor often works for me.  In particular, I often visualize my stage 4 battle as the "Battle for Helm's Deep" from The Two Towers by J.R.R. Tolkien.  It is from the the second of the Lord of the Rings trilogy and I'm visualizing the scenes from the movie version, by the way.  Helm's Deep is this awesome fortress which is ideal for repelling a long siege.  The good guys are stuck inside, well protected but with finite supplies.  You can see the endless lines of orcs marching toward you.  They can only get so close and you can kill off one wave at a time.  But sooner or later you will run out of supplies.  Your only hope is that unexpected reinforcements or secret weapons will descend from the hills with the sun behind their backs and somehow manage to kill off every single orc.  It is a long shot but you are on a heroic mission so there is always hope.

I wish I could believe in a magic cure metaphor rather than a battle metaphor.  Just click my heels together 3 times and I will be transported to safety. Who wouldn't want that?  But it feels pretty good to have made peace with chemotherapy.  Maybe love is too strong a word.  Maybe the word is trust.  At least for now I am grateful that this chemo is repelling "orcs"  and leaving me enough strength and feelings of well-being to establish something that feels a bit like normal. 


Wednesday, December 31, 2014

Bring on another year

Not a day goes by without contemplation on how lucky I am to have made it this far and in this great a shape.  There is a dab of survivor's guilt when I see others, some much younger fall by the wayside and still others suffering from the side effects of chemotherapy while I enjoy the taste of food, good energy and full locks of lustrous hair. This will be my third New Year celebrated since my cancer diagnosis; each of them provoking me to wonder whether this would be the last.  I am very excited at the possibility of welcoming in four seasons, a year of new birthdays for family and friends, deep conversations over breakfast, experiencing new books and movies and perhaps old ones I have missed, births, new technology, scientific breakthroughs, and great stories of success from friends, family and acquaintances.  I may even skip the third "Hobbit" installment; something I worried about being around to see when the first installment came out back in 2012.

Yesterday I squeezed in my last doctor appointment and chemo treatment for the year, taking advantage of having maximized co-pays and deductibles for everything.  Alice was still in town  and came with me.  I had been a bit concerned because in the last week I had experienced some pokey pains in the liver region and was wondering if that was a signal of returning cancer activity.  But the "tumor marker" blood test had not spiked so we are assuming that it is still in check with the current treatment.  In fact, Dr. Krajewski had done a bit of investigation and found several doctors who were willing to apply this treatment even when platelet levels were as low as 50 (thousand) and so he is moving the regimen interval back to every two weeks (It has been every 4 weeks, recently) to see if we can can buy some chemo "off" time in the near future.  I am happy for this, as the alternative is to switch to a different regimen, likely one with worse side effects.

Alice also joined me in the chemo lounge for a while.  It is still an interesting place for people watching.  She observed that I appear to be a veteran already since all the staff know me (and vice versa) and I am aware of little idiosyncrasies about the place; where the electrical outlets are, beverage choices and locations, tech talk with nurses, how the bathroom sinks appear not to have hot water running through the pipes, protocol with the pharmacy, etc.  A few days earlier we had popped in for the aforementioned tumor marker blood test and the receptionist (Jen) had implored me to grab a gift bag that someone had donated to cancer patients at the center.  It felt odd to me to be lumped in to that group.  I imagined the gift bags were for those without hair, pale in color and walking slowly, clutched to a concerned love one.  I sheepishly accepted a bag that contained warm socks, a winter hat, Jolly Rancher candies and a rolled up fleece blanket.  (The latter has since been dubbed "the cancer blanket" and has been cuddled with by all who take a seat in our living room and spot it there on the arm of the sofa looking all cozy and comfortable.)  I am a cancer patient but I do not feel like one most times.

Alice introduced me to a trivia game for the iPad and we played that for a while before she switched to her book and I to the "Serial" podcast that she had turned me on to a week earlier.  I had brought headphones for this purpose and discovered it to be a wonderful way to pass the hours in that chair.

It was a great holiday filled with family and love and good food.  I'm looking forward to doing it all again next year.

Wednesday, November 19, 2014

Who cut the cheese?

Not me.  But I did attempt it.

When I was a kid, maybe 8-10 years old, I had a folding pocketknife and a block of balsa wood and I was very excited about transforming the wood into some sort of a creative figure.  It was not long before I sliced into the base of my left index finger and was required to get 4 stitches.  When the bandage finally came off I was as shocked to see those 4 thread loops attached to my flesh as I might have been while looking at Frankenstein’s monster’s brain transplant scar.  It felt like a really big deal.  I remember getting them clipped off too and being surprised at how low-impact that procedure was.  That scar, its sensitivity, and the visible needle-hole scars were show-n-tell material and also key toward my learning “left” and “right”.  I just had to remember scar = left and I could sense my left hand without looking.

Another thing I remember about that experience was my dad telling me how now that I had cut myself pretty good, I would forever come to respect sharp blades and could be trusted to not cut myself that way again.  It did work for a while but as of yesterday, I now have a total of 4 scars on my left hand, three of them from knives.

Back to the cheese.  I had just returned from some white-knuckle freeway snow driving which gave me plenty of time to think up what I would be cooking for dinner: Macaroni and cheese with broccoli.  We were all pretty hungry and so I engaged my special skill in high speed, multi-tasking cooking.  The water was on the boil seconds after I arrived in the kitchen and this bought me time to do the prep for the cheese sauce. The roux was bubbling shortly after on the second burner. I like a multi-cheese, cheese sauce and I had already imagined the 3 cheeses that would be going into this one.  The sharp cheddar was easy. Cheddar is a crowd pleaser that shreds easily in our hand-cranked cheese shredder. I soon had a generous mound.  The dried pasta went into the now boiling water. 

The second cheese would be this delicious French cheese that had started off as a large soft wedge and now was a smaller, hardened wedge; not so appealing any more for crackers but I knew it would melt nicely in a sauce.  Feeling the magic happening, I grabbed a bottle of IPA that was beckoning, mere inches from the cheese drawer and popped the top and took one swallow.  I figured I’d drink half with dinner and save the other half for later when the stomachache from over-eating had passed.

I was thinking about the third cheese, which would be just a dash of a stinky cheese, a Stilton, for a little contrast.  I picked up the French wedge and realized I’d need to trim it a bit to fit in the rotary grater.  By shaving off some of the hard corners, it should just fit.  I grabbed a small kitchen knife that had been lying on the counter since this morning when I had sharpened it and then cut up an apple into eighths for time-lapse snacking.  As I brandished it against the cheese, all of a sudden I felt a zing in my thumb and had the now familiar “oops” sensation that is frequently accompanied by the, “Can we roll back time for just a minute” fantasy.  A glance confirmed that it was pretty deep.  I wrapped a paper towel around my thumb and held pressure on it with my grip.

I called for Mary but she had already heard the shouted expletive and was on her way.  I informed her that I might need stitches but in the mean time, could she hunt down a few Bandaids.  My pasta water, meanwhile, was ready for the broccoli and the white sauce was ready for the cheese.  Part of my speed cooking for this recipe is cooking the greens with the pasta.  I sliced the broccoli florets right into the water as if I was whittling a stick.  Mary came back with a couple of bandages but took one look at the blood-saturated paper towel and decided this dike leak needed a bigger thumb, so to speak.  I had her grate the French cheese in the rotary grater while I pounded the rest of the bottle of beer.  I figured that would be about my stomach capacity and the Mac-n-cheese could be warmed up later.

I strained and stirred together the pasta/broccoli mixture with the cheese sauce and called Marlee for dinner.  Meanwhile, Mary asked Siri about the closest Urgent Care facility.  Siri suggested that the closest one was on Leonard Street near the East Beltline.  We had not heard of that one but Siri was willing to dial the number to find out how busy they were. Despite the snowstorm, they were pretty slow.  So Mary pulled on her boots while I located some gauze sponges to rewrap my thumb.

We arrived to find no line and a nurse came right out to assess the damage.  He ascertained that it was probably worth a few stitches and so we filled out paperwork while they prepared an examination room.  One of the questions was, “Do you have any concerns about your injury affecting your critical day-to-day activities?”  Mary suggested that hitchhiking might be affected so we put that one down.

I was feeling pretty happy from my hastily consumed 7.5% alcohol brew on an empty stomach. And you can kind of see that in this picture.
 
A wonderful Physicians Assistant named Lara came in and made conversation with Mary and I while her assistants readied for the procedure. P.A.s are the best.  They always seem to be good communicators with great skills to back them up.  The first step was to numb my entire thumb.  She did not want me cringing and pulling away while she sutured.  She informed me that this numbing procedure was the worst part and that it would hurt a lot.  Yeah, it hurt; three deep pokes with a burn.  But her prep warning made me expect and prepare for the worst, but it was all tolerable in the big scheme.  I did not feel a thing while she was sewing.  We think she used 4 stitches but I wasn't about to watch.

No shoveling snow or dishwashing for a week…  well that is a big pain in the butt.  But the good news is that the warmed up Mac-n-cheese + broccoli was delicious; maybe my best batch ever.  And actually, this bandaged thumb may work out great for hitchhiking.