One week until Christmas

The women at the receptionist desk at Lacks Center appear to really love Christmas.  All were decked with boughs of holly and every other imaginable holiday glitz.

Today was my the review of my one month liver ablation scan with Dr. Pimiento's awesome physician's assistant, Abby. I think I may have mentioned before how much more information you get from a P.A. than you do from a doctor. They seem to have time and interest to talk about any issues or questions you may have.

Abby said that Dr. Pimiento was pleased with the scan results.  They seemed to accurately reflect his experience in the operating room.  There was one margin that was less than conclusive but it appeared that the ablation did what it was supposed to do.  That is all one could expect from a one month scan. A 3-month scan would tell a little more.  Abby powered on a CT scan viewer and pulled up my record to show me first hand.  But for some reason, we could not see the affected area standing out from the layers of liver slices. She decided to see if she could grab Dr. Pimiento, adding, "He is really good at reading scans; really as good as a radioligist. He's quite amazing."  This made me feel good. I like unsolicited praise regarding the people who treat me in such an intimate way that I barely know.

Shortly, Dr. Pimiento came in and I was reminded about how much I like him.  He has great bedside manner.  He remembered a few details about my personal life like my job and family giving me great, friendly eye contact.  As advertised, he handled the scan viewer software like a boss, switched to a different setting and pulled up "before" and "after" scans side by side.  The "after" scan clearly showed a shadow created by the necrosis of the ablation.  He showed me the questionable edge which could be explained by the presence of an artery.  Rather than a perfect orb, there was a little pucker on one side. The ablation shadow appeared to contain the space formerly occupied by the tumor.

"I think we really burned the hell out of that tumor", he added proudly.  I detected a little gasp from Abby at his salty language but I really appreciated how accurately he reflected my attitude on the matter.  "If we discover that there is still a little bit of it there after the 3-month scan, we can do the procedure again, or perhaps try isolated radiation, as long as the cancer does not turn up anywhere else."

Feeling healthy and robust, it is difficult to embrace any "what if" scenario.  It is easy to see myself as once again miraculously being cured of a fatal disease.  Maybe it is short term, but all these short terms add up to a long term.  I feel so lucky. I am continually aware of others who have been less lucky with their encounters with cancer.  My friend, Sister Jude Bloch succumbed last month. I had run into her a few times at Lacks and she always displayed a great attitude. I feel waves of sadness and small pangs of survivor's guilt.  I can only see Jude with a big smile and jolly disposition in my mind's eye.

I know that three months will whiz by quickly. Christmas, New Year's Day, Valentine's Day, Presidents' Day and ML King Day will help measure the time.  I've got a lot of life to squeeze in. It's all good.

On the way out of the office I learned that today was "wear a gaudy Christmas sweater to work day", which explained the over-the-top holiday clothing expressions in the office.  I should have guessed.

Ablated updated

I've been through all the good drugs today keeping me sleepy, silly, itchy and pain-free. They're not letting me have solid foods yet so I have been cycling through all the hospital's clear liquid offerings; broth, jello, Popsicles, repeat. I had to ask, "Why no solid foods?" Apparently they don't want to risk my nausea causing me to puke. That would not be a good thing to be retching when you have a liver that's in a sensitive condition. But I really do feel great. Not much pain and good spirits.

I had a doctor whom I had not met before, slip into my room earlier and spent about 30 seconds telling me that the surgery went "beautifully". Her word. It is nice to know that the mass is now toasted, and therefore an impotent mass.

My job now is to relax for about a week. I think I can handle that.

____________________________________________________

I wrote the above entry the evening of my surgery while sitting in a hospital bed.  I just realized that I forgot to hit the "publish" button, which explains all my family members checking in to see how things went. That was yesterday and today I am resting in the comfort of my home, falling asleep while watching documentaries on Netflix.

Right after I wrote that, Dr. Pimiento popped in and gave me a more detailed account (and also updated my chart to include solid foods).  He was a bit more reserved in his analysis about how things went.  He said the mass was a bit oblong and so he blasted it with two intersecting orbs of tissue death.  He also said that one of the wires did not heat up, probably due to the heat sink properties of a local artery.  He said we would check it in a month to see if another treatment would be required. 

Dr. Pimiento reappeared first thing in the morning to prepare my discharge papers.  When does that guy sleep?

One thing I forgot about surgeries and hospital stays is all the poking that happens... and bad poking.  They needed redundant IVs plus an arterial line and for some reason could not use my port.  The Nurse assigned to poke me before surgery failed in her first two attempts.  Thankfully, she called in someone else who managed a successful tap in the other arm and at that point the Anesthesiologist with a cool Russian accent stepped in and said she would do the other one after I was asleep.  At Lacks, you get regular heperin injections plus an early morning (as in 5:00 a.m.) visit from the hospital vampire charged with gathering blood samples.

Right before leaving, I had a surprise visit from Amy, the Lacks nutritionist who was making her rounds with an intern in tow.  She introduced me as her "fastest healing patient ever" and added that it was not an exaggeration.  She has never seen anyone respond better following major surgery and major chemo.  At least that is what she said.

Everyone was incredibly nice at the hospital and took care of all my little needs but it is good to be home.

A new doctor and a new approach

On Friday, Mary joined me for a consult with the Lacks Center's new surgeon, Dr. Pimiento (who replaced Dr. McCahill, the surgeon who relieved me of my esophagus).  His nurse went over my medications and it is clear they were picking up from Dr. McCahill's records because all the medications were what I was taking after my big surgery a year and a half ago. She got them up to date and shortly Dr. Pimiento whisked into the room.

Dr. Pimiento is a highly engaged, good-looking, young, Latino with a heavy accent and expressive manner.  He launched right into everything he knew about my case, summarizing medical events from the beginning up to what had happened last Tuesday. He then asked if I had seen the x-rays.  I had not but I was glad he asked because I always want to see pictures.  He quickly pulled in a cart with a monitor, called up my CT scan and navigated from the neck down to the spot on the liver.

It was rather a disappointment as I was expecting an ominous, dark, ugly blotch, but it was more like a shadow.  (In the picture to the left you can see it in the yellow crosshairs measuring its size as 23mm x 19mm.) He showed how it was fairly deep into the liver and reiterated how difficult it was for Dr. Skrtic to see with his ultrasound on the outside and the ribs blocking the best views.

He agreed that the ablation was still the best alternative but that it was fairly experimental because my case was unusual and there was very little data on metastasized esophageal cancer in the liver.  If it was colon cancer, there was lots of data showing that liver resection was the most successful approach resulting in longer survival periods.  But so far, all my cancer activity has been limited to this very small area for a fairly long stretch of time and this minimally evasive procedure with a short recovery period and low risk seemed to make good sense.

He then went on to talk about how much he loved doing a liver resection and how it was a beautiful operation. Mary thought that the way he talked about the liver was pretty sexy.

The surgury involves inflating the gut with CO2 to give him room to work and poking a couple of holes for instruments, including an ultrasound wand placed inside this time. The ablation catheter must be plaed exactly in the center of the tumor because it kills tissue within a sphere and all the cancerous cells must be on the inside of that sphere.  It takes 3 months before you will know if you were successful.

 He said that he could do the surgery on Monday but since he wanted to have a radiologist on hand, it was too late to arrange this for this coming Monday so he put me down for the first surgery of the day a week from Monday on the 11th. There would be one night in the hospital required and week staying home from work.

I'm a bit anxious to have this done but I can wait a week.

Good concept, failed execution

The short version is this: The ablation was unsuccessful due to the very inconvenient location of the tumor.  They will likely try again next week with a slightly more invasive procedure for getting at the tumor for ablation.  If you like gorey details, read on:

My brother-in-law, Bruce, delivered me on time yesterday morning to St. Mary's Hospital Intervention Radiology department at 8:30 a.m. for the ultrasound guided ablation procedure.  A very friendly nurse named Darcy (who had also called me at home the night before to fill me in on details) got me ready with the standard issue gowns, one-size fits-all pants and non slip slippers (an oxymoron?). The I.V. was a breeze because she was able to access my port.   I was further informed about the procedure by Kevin, a physician's assistant and then again by Dr. Skrtic himself. All seemed confident of a good result.  Feeling incredibly well-informed having it explained to me be nurses, P.A. and the doctor twice, I was beyond ready to go.

There must have been some kind of emergency because I had to wait an hour beyond the scheduled 10:00 operation time.  When they finally rolled me in, I was prepped by a nice person named Meghan who offered me a choice of Pandora channels to listen to. Dr. Skrtik came in to pre-visualize the tumor using an ultrasound wand and a giant TV Screen suspended on a gimbal above.  I can tell you that a liver is a less gratifying site on an ultrasound display than say, a baby. I really wanted to see what a tumor looked like but it was tough to see anything that looked like an ominous mass. Dr. Skrtic was having a difficult time seeing it to.  It was in a really difficult place to visualize, on top of the liver, behind the ribs. Ultrasound cannot see through bone.  He had me run through a series of breath-holding options and seemed to have decided to go between the ribs.  But then he tried a wedge on my left side so I was at a 45 degree angle with one arm above my head.  He moved to the other side of the table and found a position he liked better.  It required a smaller "breath-hold" from me and the approach was under the rib cage.  Satisfied with this strategy, he then left to make some measurements from last week's CT scan to establish depth. I could see him working oin the corner of the giant monitor.

Three other people with masks came in and began hooking up equipment.  One of them must have been an anesthesiologist (although she did not introduce herself) because I felt a cool liquid flowing into my port and felt the effects of the Versed. This was to be conscious sedation and I knew that they would give me enough to feel groovy but not so much as to put me to sleep.  I found it no problem to remain engaged with what was going on around me.

There was a big box next to me and all three people seemed to be hooking it up for the first time. They were looking for instructions and trying to figure out where patch cables and a five-channel piece of tubing were supposed to go.  Eventually, Dr. Skrtic reentered and joined them in trying to figure it out.  It seemed to me that they were struggling with this for about 10 minutes.  I was in an altered state but from my angle I could see a slot with five channels where it seemed likely this tube was supposed to be inserted. Eventually, Dr. Skrtic lifted a block on some sort of hinge that revealed the five channels that I could see and everyone seemed satisfied that the mystery was solved.  At least that is my spaced-out recollection. It could have been a dream.

When the operation commenced, Dr. Skrtic started with local anesthesia, warning me each time about a "pinch and a burn".  Each shot went to a deeper layer of tissue and I found them easy to handle.  My strategy for shots is to drive a fingernail into my side with self-inflicted pain distracting the needle pain.  The catheter was then painlessly inserted.  I tried to watch on the monitor but could rarely see anything that looked like anything. Repeatedly, he asked me to take a deep breath (or a medium breath or a small breath) and he would push in a little farther.  These often did hurt, similar to the pain of getting the wind knocked out of you.  Deep and unfamiliar.  I wanted to tell him to just push a little harder and get it over with.  Eventually I felt myself getting a little clammy and wondered if I was in danger of passing out.  The shoulder above my head was getting sore and at one point I think I moved my arm for relief and somehow brought it into the operation arena, touching skin. I remember a barked order to restrain my arm and re-sanitize the area.

Then I remember instantly realizing it was over.  I must have fallen asleep. No one was working on me and there was only one other person in the room.  Somehow I gathered, or was perhaps informed, that they had given up.  The tumor kept sliding out of the way whenever he pushed into it and he would also lose site of it on the ultrasound.

Bruce filled in the gaps with these notes:

Before you came back into the room, Dr. Skrtic came and gave me the overview directly after finishing your procedure. He was disappointed he couldn't lance the mass because it moved up every time he poked it, seemingly up and under the ribcage if I understand it correctly. He said the placement of the needle was tricky and though in one attempt he could get approx. 1/2 cm into the mass, it slid back out with normal breathing, as you recall…

He said it was important to know for certain that the placement was perfect before applying the zap, (my meager attempt to remember the term) so that's why they abandoned the effort.  He said you did an outstanding job, it was the limitations of the device under the circumstances and normal breathing mechanisms that were a reality… so know you were doing an excellent job throughout… The seven or so times you tried were exceptional, it was simply a mechanical issue -- the diameter of the needle (thick as a ball point pen tube he seemed to suggest, because of the prongs stored inside of it) that kept nudging the mass away.

So then he straightaway said there's two options, and that had he had permission, he would have attempted the pure alcohol ablation, with a much thinner needle which would have more easily made it into the center of the mass; the idea being to then inject pure alcohol in proportion to the volume of the mass and attempt to destroy the tissue. He said that's the effect of pure alcohol on the mass. He also said that had been the standard procedure they all used regularly up till the radio frequency method was developed.  So he would have done it yesterday, yet was considering doing that even this week… just needed permission, scheduling, etc., and since you were "snowed" (his word) yesterday, he couldn't proceed.

However, this is interesting - it's possible the delay will likely be the best thing that could have occurred!  When you came back into the room, he visited, and again said to you there's two options; one being the alcohol ablation and the other - minimally invasive laparoscopic surgery to ensure plenty of access, the latter being more invasive, but he wanted to consult with Dr. Pimiento (sp).  So, a bit later Darcy said they were on the phone, comparing notes and looking at the scans, etc., and then sure enough Dr. Skrtic came back to tell you the laparoscopic method seems best. That's interesting, because Skrtic said while the alcohol treatment is very effective, he didn't seem to say it's 100%, and Darcy reinforced that idea saying it's often possible to re-do the procedure as needed over time… However, in describing the details, Skrtic said the laparoscopic procedure enables them to use CO2 to easily expand the space to work, etc., etc., and with surgery you get more of a guaranteed exact placement of the same radio frequency technique preferred.  He also mentioned they sometimes get him up there in the OR to help during the operation as they as really good at assisting with guided imagery technique.  Then, Darcy in a separate conversation later said she too knows the RF is preferable -- the fact being that radio frequency technique has much better precision getting a larger area and any "feeders" (her word describing blood supply that is hard to see) and with the extended radius of area covered by the 'zap' you are in much better shape. And she said again, that because you're such a healthy person, and can live fine with some loss of liver, she seemed to suggest 'why not'… and that it's a much preferred solution in her experience.

 Back in my recovery room, I was very hungry.  I had to wait a little bit and was given some juice at first and then eventually a chicken salad sandwich and some orange sherbet. Bruce was still there, getting details and instructions as evidenced above. I made a few "Facetime" calls and emails and sent Bruce home while I slept for much of the mandatory 5-hour waiting period.  Mary and Marlee picked me up around 7:00p.m. and when we got home, Marlee made me some macaroni and cheese while I rested in an easy chair. I took a Vicodin but was not in much pain

Again, the emotion is disappointment. All that rigmarole plus a lost couple of days and the tumor is still there, un-burned and growing. Next week, a new doctor and another procedure.  Until then, moving slowly.

Burn tumor, burn

I met Dr. Skrtic this afternoon.  No, that is not a typo. His last name simply lacks enough vowels for a proper two syllable word.  It's pronounced "Sker-tic".  Dr. Skrtic is an Intervention Radiologist.  He gets called in to do the highly skilled procedures that involve visualizing beneath the skin using ultra-sound equipment, X-rays and CT scans. 

I first sat down with a Physician's Assistant named Brad whom I also liked. In my limited experience I've found Physicians Assistants to be both knowledgeable and and good communicators and they seem to be less in a hurry to escape a barrage of questions.  Brad fit this description and did a good job of making me feel like I was being heard.  We talked about my past experiences with liver biopsies and the challenges of getting to a spot resting on top of a liver.  He told me that Dr. Skrtic was just finishing a procedure and he would be with me shortly.

It wasn't long before Dr. Skrtic arrived.  I liked him right away. He was also a great communicator and did not seem impatient.  I really liked that he conveyed how much he enjoys the trickier, more challenging procedures and that he was very interested in working on my case.  It had been presented to him at "Tumor Board", a regular meeting of oncologists who go over interesting cases together to share ideas about what would work best.

He did say that most often the metastasized cancers that migrate from other areas typically come from colon cancer and that esophageal cancer is much rarer in the liver.  In fact, there were no statistics about how effective this procedure would be for this type of cancer but in other ways it was a perfect case to apply this treatment.  My tumor is 23mm and the maximum treatable size for ablation is 30mm (3cm).  And it is just in the one spot and I am otherwise in excellent health.  Ablation effectively kills all the living cells in a 3cm sphere and thus, all the visually active cancer cells identified as thriving inside my body.  I have often visualized wanting to be able to do just that; fry the little sucker. If I understood him correctly, it uses radio waves to heat up tissue to just over 100 degrees, making a little localized "fever" that engages my immune system to kick into gear and cut off the blood supply to this area. I'll be left with some scar tissue on the organ but a liver is robust enough to handle it.

Brad came back with a "surgery" date of next week Tuesday, the 29th at 10:0am.  They want to treat me soon so the tumor does not grow to exceed the 3cm limit.  It takes an hour and then they'll watch me for most of the day to make sure there is no bleeding (there are lots of blood vessels in a liver) and then send me home to chill for a couple of days. 

I'm very excited about this approach.  No guarantee of success but it just feels right... and is much more palatable than another round of chemo.

Interventional Radiology

I got a call from lacks Center this afternoon.  I have an appointment next Thursday with an Intervention Radiologist to discuss options.  Found this video that describes the procedure:

I guess I'll find out if I would be a good candidate.  I think I could find a pair of gray undies.

Change of seasons

Autumn is a time to reach back into the closet and pull out that thick sweater that you put away mere seasons ago.  That sweater smells and feels like another time and pulling it over your head brings back memories and feelings and anticipation of change. The sweater I dug out of the closet this week was the one that I put in there with the fantasy that it would stay in there getting threadbare and musty and would be revisited as only as a faded memory.

Last week I had my 3-month CT Scan after a year of great health and good energy following that weary summer of chemotherapy.  I knew that my scan would be clean because my body and spirit were so on top of the world.  But the minute that Dr. Scott came into the room after reading my report I gathered that the news would be different this time.  Instead of a proclamation about great test results, he began asking if I had any pains or congestion, and did it hurt when he touched me here or there.  “No, I feel great!”

At the end of the exam, he sat down and showed me the printout of the summary analysis and explained that the CT scan had indicated that the previously inactive spot on my liver had grown from 7mm to 23mm; still very small but clearly active.  He then showed me the blood report where the “tumor indicator” reading had spiked from neutral to positive.  This second report pretty much confirmed the first.  The esophageal cancer in my liver was back.

There was a second anomaly in my right maxillary sinus, which showed a “development of opacity”.  This could be nothing but it will need to be checked out.  I have no pain or pressure so I am pretty sure it will turn out to be nothing.

I have no feeling of shock; just some disappointment about having to let go of the affirmation that I had been healed. I wanted the doctors to be wrong about their sureness of a malevolent return.  The worst part is the disappointment of others who shared this fantasy.  It was easy to believe in the wrongness of doctors and their remote diagnoses.

I still know very little about what this will mean about my immediate future and my new job.  Dr. Scott said that he would be taking my case to his oncologist roundtable to gather a consensus about what steps should be taken next.  He suggested that maybe they might try an ablation.  Using radio waves at point blank range, they would fry the tumor (with a little onions on the side). That’s one possibility.  I asked about another round of chemotherapy and Dr. Scott said it would come down to weighing quality of life versus invasive procedure.  That sounds a bit too much like a palliative care issue.  I’ve been in denial about this whole “making life comfortable” thing.  I can handle some discomfort.  I really enjoy seeing what comes next in life.

My friend Bob Russell succumbed to his esophageal cancer in late August.  He had entered into Hospice care back in June and was spending his last days on Glen Lake, just spitting distance from Gram’s cottage.  I visited him just a couple of weeks before he died while I was up there staying with my extended family at the cottage. He was in good spirits and we had a lucid conversation about recognizing the end.  For him, the cancer had spread into his brain and after valiant attempts at getting it under control, he finally conceded that it was time to let go.  He told me that he knew that his skills and intelligence were no longer viable for solving problems or contributing to society in any way.  He added that there were two things that still needed to happen: One, his loved ones need to find a way to let him go. And two, he needed to find a way to let go of life, himself. “It’s damned hard”, he said. “I don’t know how to do that.”

I feel that I am a very long way from where Bob was on that day.  I’ll likely get there sooner than most of you reading this, but right now it feels like that day is still years away.  We are all dying and you never know when and rarely how. Any of us can die on any day.  I could get hit by a car while crossing the road and so could you.  We should all live for the day and enjoy every minute and embrace every situation, good and bad, as an interesting experience that we are privileged to comprehend at this moment.

That sweater is back out of the closet and stretched across my torso and I find it a bit itchy and uncomfortable but I quickly remember that I get to experience another change of seasons. It does not feel as bad as the last time.  I’m grateful that I can go back to work tomorrow.

Out of retirement, into the fire

So I got a job.  This was highly unexpected. I had pretty much resigned to an early "retirement" living on Social Security Disability and doing "love" projects as a volunteer and avoiding any long-term commitments.

One of those "love" projects was helping out my friend Kim Dabbs who is the new Executive Director of a local organization, the West Michigan Center for Arts and Technology (WMCAT) with a video project. This is an organization whose mission has always interested me and I was happy to contribute in some way.  I met several of the staff through my volunteer activities and my esteem for the organization grew.

Unrelated to those volunteer activities, I started seeing references (on Facebook and some email lists I belong to) to a job opening teaching video to teenagers part-time.  Of course this interested me.  I thought I might be able to refer this job to ma friend. When I read the job description I kept thinking, "Wow, this would be a perfect job for me if i was not retired.  My resume perfectly matches their requirements too." But I am retired and so I forwarded it on to some friends and tried to forget about it.  After all, who would hire someone with stage 4 cancer for a 9-month contract anyway?

While I was up north at Glen Lake for a vacation, I received an email from one of Kim's WMCAT staff members in charge of the youth program asking me if I knew anyone who was qualified as they were having a hard time filling the position.  I replied that I would send the description to a few of my friends and then I added, "I'm tempted to apply, myself."  She replied, encouraging me strongly.

I guess I nailed the interview.  I really had nothing to lose.  And now I find myself contractually obligated to survive another 9 months in good health as I teach two groups of 12 teenagers how to make videos with community partners.  I meet each group twice per week in the afternoons, Tuesday through Friday.

I'm incredibly impressed by the other teachers and staff members and humbled to be accepted into their company.  They all LOVE what they do and assure me that this will be a rewarding experience.  I'll meet my students for the first time at a retreat the weekend of September 20.  Until then, I need to come up with equipment and curriculum plus the courage to embark on a new adventure with many unknowns. It will be a leap of faith, but so far the signposts are all very positive.

Here goes!

Do you need a port when there's no storm in the forecast?

I've been given another clean bill of health this afternoon!  Dr. Scott wonders where he went wrong thinking I would be a very sick man by now.  Now that's glass-half-empty thinking! He's now giving me another 3 months of doctor-free living before the next scan and if that one comes out clean too, he's going to recommend that the port be removed. Those 3 months will also mark the end of a full year since chemo ended.

A port is really no trouble except that you have to have them flushed out every six weeks so that they don't clog up. That means a trip to the cancer center.  It is really nice to have a port if you are going to undergo chemo and they are also pretty sweet as an alternative to an arm poke I.V. when you have a scan done.  The scanner technicians push the dye activator pretty fast and the fluids feel much more comfortable going into a great big receptacle on your chest than that very soft, sensitive flesh at the arm joint.

A port is also a physical reminder of cancer and cancer treatment.  I've got scars, a bald head, small stomach, tingly extremities and skinnier frame that also remind me on a regular basis, but the port is this artificial appendage that specifically speaks to the potential of more chemotherapy.  It would be nice to feel like I am completely done with that phase.

On the other hand, if the cancer did come back would I be given chemo again?  Would I be given a choice? I tend to think that I lived through it once and I could live through it again.  I really enjoy being alive and I know how good it feels to come out healthy on the other side. If I did have to go through chemo again I would surely want the port.  Should I tempt fate?

I've got one more scan and three months to think about it.  I can't help remembering that every single tube ever placed inside of me felt like an important crutch and I feared having them removed but in every situation my quality of life improved dramatically after they were pulled out. The port is the least intrusive of these and I'm not sure how much more room I have for improving the quality of my life anymore.  It's pretty damned good already.

The closet

Looks like it has been a month since I have been compelled to write in this forum.  It has been a great month!  I've been describing to many my feeling of elation; waking up happy, enjoying my days and then going to bed happy at night. Spring moving into summer is definitely a factor. Warmth and renewal does a body and soul good.  It seems that everywhere I go people are telling me that I look good; good color, good weight, good energy.

This week I was approaching the 3-month mark where once again I would be reminded that scans were needed to probe deeper, beyond my sense of well-being to an invisible, cellular place where dark forces could be trying to kill me. I thought that my final week of the respite would involve jury duty but after reporting last Monday, I was told that all cases had been resolved and my jury service was complete.  Lacks Cancer Center called me a few days ago to tell me that Dr. Scott needed to reschedule my appointment.  He needed a vacation and along with the holidays, it would be another month before they could squeeze me in.  My scans and blood tests would need to be postponed too.

This is good news.  I always am thinking that Dr. Scott needs a vacation.  He works too much.  And I am in no hurry to get back into the world of pokes and probes.

Strangely, however, this postponement has had the effect of steering my inner thoughts back to the idea of palliative care and mortality. I'd been expressing outwardly to friends and family that I was putting my cancer outlook in a closet.  I wanted to practice life with the notion that all had been cured. "Emotionally dangerous", some might say.  But I was thinking that a closet was a perfect place for it.  Out of sight and perhaps forgotten, but as retrievable as an old winter sweater; far easier to locate and less muddy than if it was buried deep in a damp hole in the ground.

So now I find myself peaking in the closet. Yep.  It' still there.

My friend Bob Russell recently entered into Hospice care. To me this is the most poignant reminder of how quickly conditions can change and even an upbeat and wise fighter can arrive at the point where it is time to stop the active battle.

Fortunately I am nowhere near that point.  I have no idea even what it would feel like to get those initial twinges that hint at a newly empowered disease, let alone a full-on struggle to simply breathe.  Right now I only know that food tastes really good and every day can be filled with beautiful moments and interesting opportunities.

Back to Curacao

On a vacation it often seems like you have lots of days left and then all of sudden it is the last day.  This is sort of the last day because a chunk of it will be spent on the first leg of travel home. Since we flew into Curacao, we must fly out of Curacao. When we were there a week ago we scouted out hotels and since it was just for the night, we were looking at the one hotel near the airport. But after reading the reviews on line, we decided to splurge on something nicer that required a longer cab drive. We booked the Marriott. A nice hotel will stretch that vacation feeling just a bit farther.

Dutch Antilles Express had bumped our flight to 4:00p.m. So we really had the possibility for an excursion on Bonaire before leaving. The problem was that checkout from our apartment was 11 a.m., The scooter was due back at 10a.m. and it is hard to have an excursion with no transportation and a pile of luggage.

I had this fantasy that we could still pull off going to Klein Bonaire; an uninhibited island a few kilometers out in the bay that offered some of the best snorkeling available from shore. A water taxi takes you there and picks you up. There is no shade and you must take plenty of water. We could almost pull it off... the first trip there is at 9:30a.m. and the first return is 1:00p.m.  But I could only negotiate a 1:30 late checkout and I was just not enough time to walk back from the water taxi, take a shower and be ready for the airport two hours before flight time. So we resigned ourselves to checking out some spots that were close by.

I gassed up the scooter to a full tank (about 4 dollars) before we squeezed in our first snorkel plunge before we had to return Our ride. I then scooped up Mary and we rode to the very first beach, Eden Beach, we had tried when we first got to Bonaire and this time we went deeper and farther from our towels. It was again, very pleasant.  

With wet suits, we made it back to the scooter rental place at the exact scheduled return time. From there, we walked a block back down to the ocean and surveyed our walkable options. We could plunge in anywhere but there were lots of moored boats so we chose to stroll to the end of the beach walkway and snorkel around the adjacent property.

I buried my wallet under some coral gravel, marking it with a pink stone although throughout our trip we discovered that no one really messes with your stuff and there are never that many people around anyway. Snorkeling again, we saw some new species and all of the old ones. The was the added bonus of some man-made wreckage on the bottom and also a bunch of scuba divers (I counted nine) swimming along the drop off. Quite surreal to spot humanoid shapes through the depths.

I'd left my watch back at the apartment so we had to guess about the time and our goal of getting back by 12:30. We hit it pretty much right on and I microwaved leftovers from yesterday's "Thai" dinner while Mary showered. We were mostly packed already so after I rinsed off, we double-checked for loose items and lugged our baggage down to the Dive Hut. We met Irene, the co-proprietor, there and paid for our incidentals and chatted about Island life while we waited for Broertje to pick us up in his taxi.

He arrived on time and ten minutes later we were in the airport. Check in was easy and in no time we were back in the mostly empty prop plane ready for takeoff. Once in the air, I was able to to see through the propeller to Loc Bay and then a minute later, the north end of the island where we had scootered past the flamingo reserve to Rincon and later returned the wrong way.

Landing in Curacao for the second time was reassuringly familiar and we breezed through customs after waiting an uncomfortably long time for our checked bagged to come through. We found a cab immediately and the driver quoted the amount that we were expecting via our Internet research. Ten minutes later we were in the lobby of the Marriott.

The Marriott is definitely one of the nicer hotels on the island. It is clearly an American comfort pod in an otherwise foreign land. Our bags were handled for us and iced lemonade served to us while checking in. The room was awesome and we had sliding doors that opened into a shady courtyard that led to a remarkable pool and beach with thatched shade huts scattered about.

Mary napped while I typed up yesterday's blog entry.

When Mary awoke and I finished uploading, we referred to our Marriott guide to see there was a sunset drink special at the beach bar.  We thought we better check it out. It was OK but we were annoyed by some gabby Americans at the bar who were talking loud enough for us to hear all their boring details.  We decided to check out dinner options from one of the hotel's four restaurants and settled on a casual outdoor seafood venue. We split an order of coconut shrimp, an order of ceviche and a slice of key lime pie.

Back in the room, I had a case of the hiccups so I wend back out the sliding doors and listened to the Curacao night sounds while a veiled, almost full moon looked down on me. 

We knew that our 4:00am wake up call would come too early so we got our bags ready, hopped into bed and turned on TV to HBO until we fell asleep.

//////////////////////////////////////////////////

We got our wake up call, made coffee, checked out and got into the cab that was waiting for us. We probably could have slept another hour. Why do they always say, "Be at the airport two hours early"? There was hardly anyone there and none of the check in desks were manned. 

But all went smoothly and I am writing this from 38,000 feet above the Caribbean. I watched Curacao disappear from my window and wondered if I'd ever see it again. I have all my own snorkeling gear now so why not?  

See you in Grand Rapids this evening.

Last full day on Bonaire

I'm writing this at the airport while we wait for a plane to take us back to Curacao.  (So as I write "today", I really mean yesterday. The short entry was a placeholder for those who may be worried about our safety since I am otherwise publishing regularly in the morning.)

Today was a day to travel to southern side of the island. We intended to do a swoop along the southern rim and end up at a bay that was mainly a Mecca for sailboarders but we had been told about an exceptional reef there too.   Our intent was snorkeling there. There was also a recommended authentic restaurant for lunch where we could get the fabled iguana soup or goat stew.

We decided to consume our remaining delicious mangoes in our room and have only coffee at the apartment's bar (it's called The Dive Hut).

Soon we were speeding helmetlessly, beyond good sense, past the airport, past some very attractive snorkeling beaches, toward the salt processing industry.  The ocean was on our right and the immense rectangular ponds of curing salt were on the left.  There were no trees and LOTS of wind. And every time a car or truck passed us, we were stung by flying salt. It was a pretty long loop with a threat of more of the same for a long time.  After reaching the spot where it appeared that salt must be loaded on ships, we turned around and head toward plan B: the cross-island cut off.

On this route we were headed directly into the wind, which was a little easier for scooter handling.  It also took us past the donkey reserve.

Donkeys are an island pest. Left on the island to breed on their own decades ago, their only role seems to be eating people's plants and creating a road hazard.  We met the proprietor of the reserve and she immediately snapped into the stereotype of what we think of as a crazy cat lady. She was a crazy donkey lady.  She loved them to pieces and shared with us all her best stories of rescue and anthropomorphism. We were weeping in minutes. Well, not really, but it was hard not to part with a mere seven dollars each to spend some time with them and help this lady and others like her to provide food for over 400 donkeys.

The reserve contains most of the donkeys on the island. Another 100-150 still roam free but eventually they are captured and brought to the reserve where the males are castrated and wounded donkeys receive veterinary care.  There were plenty of opportunities to donate more. Mary bought souvenirs and I put an extra dollar in a bin that showed a painting of a donkey eating dollar signs.

They allowed us to take the scooter on the dirt path that traversed their vast grounds. By the end, I was convinced that they really had 400 donkeys there. I was doubtful at first but every one of them b-lined for the scooter all along the route. Another fundraising scheme is to buy carrots to feed them. Woe to he who stops. I had wrestle our lunch bag out of the mouth of one of them.  But I must say, the little ones especially are adorable.

We escaped and soon arrived at the eastern bay or "Loc Bay". It is geologically unique to the island and also encompasses a mangrove swamp. A reef blocks in the bay so the waters are calm on the lee side but a strong wind always blows.

We were hungry so we decided to try to find "Mikey's Snacks". Our directions were a bit vague and signage is poor or non-existent. Anyway, I turned down the wrong road. It was rough and long but had some great scenery, including some relatively close flamingoes. We finally stopped at a kayak adventure place to ask directions. Yep. Should have turned one street farther down. He did help us by selling us our water recreation passes. Bonaire Charles $ 10 per person who does any kind of water recreation and this pays for clean up and preservation. It is good for a year and we were happy to pay it. Especially after we heard there is a steep fine for being caught in the water without one.

By this time, we were so hot and we were dying to get into the water.  So we backtracked but instead of getting lunch, we drove back around to the other side of the bay to find the snorkel spot. We had packed a back up lunch consisting of a sandwich made from last night's Swiss leftovers and some tortilla chip crumbs and we scarfed that along with our reserve of water.

We had been directed to go to the beach near this resort and then walk about 10-20 minutes to the place where we could snorkel and enjoy some pristine shallow reefs. It was not clear to us where exactly we should go so I went into the resort to ask. The woman I encountered at the desk had an American accent but when I said "snorkeling", she looked at me like I was crazy. (It is a rather funny word.) She told me it is too shallow to snorkel here. Nobody snorkels here. It is highly discouraged. She encouraged me to check out the beach, which we did but it was very unclear where to go from there. No direction looked like you could walk 10-20 minutes and get somewhere else.

Three strikes. We kept thinking about the sure thing... those beaches we passed by the airport. Roland had mentioned that he thought they were some of the best.  Windsock was the name that stuck in our head.

We backtracked, past the donkey reserve. Mary took a turn at driving the scooter since it was a long straight line and she would not have to deal with cornering with a passenger right out of the gate. 

We arrived at one unnamed beach and the snorkeling was pretty good.  Unfortunately i inhaled some seawater right off the bat and it caused me great discomfort and breathing anxiety. Mary was having a great day with her equipment. We saw a couple of fish varieties as yet unseen by us and some really large and unusual banks of coral.

After an hour, we scooter end on and Lund the beach called Windsock.  It had a shady place to park and there were other snorkelers here; a good sign.  Again, excellent snorkeling with several varieties of coral and all the fish. I'd recovered from my seawater gargle so I was much more comfortable.  I love how the sea floor is littered with dead coral chunks that look like bones. I kept imagining an alien autopsy dumping ground.  We were both really enjoying this spot and despite the plan deviation, we felt it was a good day with new experiences.

We returned to he apartment in time to shower off all the dried salt residue and drift over o the Dive Hut for the "Thai Dinner Night" we had signed up for.  The story told to us was that the was this Thai woman who liked to cook for them every two weeks.  We didn't see anyone in the kitchen who cold pass for Thai and the food was not like any Thai restaurant I'd been to before. There was a meatball appetizer that had some coconut in it and a spicy sauce to dip it in. It was pretty good.  Then the dinner plate came out. Chopped up chicken and broccoli, a pile of white rice, an undressed salad and a chive omelet. Tasty but it had no name and did not seem very authentic to us.

We retired to the room, waiting for my over-full stomach to adjust and then at 9:00 we hopped back on the scooter one more time to check out a recommended ice cream joint. It was homemade gelato and was quite delicious.

When we jumped back on the scooter to go home, it would not start. The electric starter turned over and over but it would not catch. A friendly, young local man passing by said to kick start it. I had no tried that before but I could see it would need to be up on the kickstand to do it. The man helped me to put it on the stand and then gave it one sharp kick and it came to life. He gave me a fist bump and we zipped home for another good night's sleep.

No time for real post

In case you are worried that if I didn't post it means we have driven the wrong way on a one way curving mountain road and plunged over the edge... Your fears can be relieved. The scooter is returned and we are preparing to leave Bonaire for Curacao. Yesterday we pet donkeys.

Adventures in Bonaire

We woke up to a cloudy day. There had been a little rain overnight as well. That's not really such a bad thing when your agenda is an open air scooter ride around the island. The sun is the killer element.

We breakfasted out of our fridge eating fresh fruit and peanut products but stopped in for coffee at the Dive Hut; the bar associated with the apartments. We met Irene, the co-proprietor of the small complex and she encouraged us to try "Swiss night" at the Hut. She explained that she is Swiss and they cook Swiss cuisine once a week. We added our name to the list.

After coffee, we we went back to our apartment, packed for our day trip and sped off up the coast on the scooter. 

After we passed thee last dive site, we saw no other cars for some time.  It was a protected no-dive zone, preserving a pristine reef. The road finally cut in an easterly direction across the island and along an inland lake that was a nesting area for the Bonaire flamingoes. It was lovely and we saw lots of birds and iguanas but we saw only one lone flamingo. It was satisfyingly dark pink and at first we were not sure whether we were looking at a decoy/lawn ornament or a live bird. I say it moved.

At 11 a.m. we rolled into the town of Rincon. We were looking for a restaurant called Rose's Inn which had been recommended as an authentic local place to eat. Calling it an "Inn" is a misnomer. It was an outdoor seating area with a booth at the entrance that served as a kitchen. We were told to sit anywhere and except for a small collection of local men sitting near the entrance talking to whomever was in the booth, we were the only ones there.

Eventually a woman came out and took our drink orders. There were no menus but we established that they had beer and fruit juices so Mary ordered the former and I the latter. She asked what we wanted to eat and we asked her what she had.

"Today I have some salt fish, chicken stew, beef stew or I have a tuna sandwich."

Mary asked about Iguana soup, which had been recommended, but we were informed "no soup today." She then walked away saying, "you think think think about it."

About a half hour later, our drinks were gone and another couple entered and we heard them order food. Their lunches were prepared and served and and she had not yet returned to our table a second time or even shot us a glance. It was a lovely place to sit with good music playing but we were pretty hungry. Finally Mary managed to signal the woman who came over and took our orders. We had probably been sitting there nearly an hour. Glad I did not have my watch on. Was this the pace of the Island? Had we said something wrong?

The food definitely was fantastic. I ordered the salt fish, not really understanding what I would be getting and Mary ordered chicken stew. They both came with a lettuce salad, corn cake, bean cake and fried plantain. I had French fries and Mary had a mound of spiced beans and rice. Salt fish was delicious. I think it was tuna fried with...something. Mary loved the chicken as well. Getting the check proved as difficult as waiting to be served but we eventually payed and scooter end out of there. Good food. Awkward experience,

We looped backed to the coast on a different route. But when we came to the split, we discovered that the road we had been on up the coast had turned into one way beyond the dive sites. I never saw a sign. In retrospect, that is probably why we never saw any cars coming the other way.  Looking at a map, the only way out of there looked to be back-tracking to Rincon and circling the long way around on the windy side of the island, far away from all the snorkeling sites.

This may sound like a stupid decision but I chose to drive the scooter the wrong way down a single lane road for the couple of kilometers to the point it becomes two-way again, at the dive sites. To Mary's credit, she thought it was a bad idea but she held tight and we white knuckled it around each curve. I knew there was almost no traffic and if I went slow and pretended I was more like a bicycle and less like a motorcycle, I could get away with it. On the 3 occasions that I saw a car coming, I pulled over and stopped. Only one person wagged a finger at us. Hey, we are driving a power scooter without helmets. Why not go all the way to retarded? But you will have to trust me that this was the correct decision and never really felt that scary to me. And Mary got a nice jolt of adrenaline out of the deal.

We were anxious to try out the new modified goggles with Mary' lenses glued in to them.  They worked acceptably well. 

We decided to try diving at a spot called 1000 steps. There are only 64 steps but apparently it feels like 1000 if you are arriving scuba gear up the flight. There was beach at the bottom and secluded nooks for changing out of wet gear. There is not really sand in Bonaire. Just dead coral chunks and finely ground coral. This beach had quite a bit of the latter and since it was a fairly windy day, the water had it pretty stirred up and cloudy near the shore. There appeared to be very little live coral here and not as many fish as yesterday. At one point I looked for Mary and she was out in much deeper water. I swam out to her and discovered that she had found where the live coral was. It was a forest but it was maybe 20 or 30 feet deep so we were quite far above.

We swam for at least an hour and we were the only ones left of the 6-8 people who came and went while we were there. We changed back to dry clothes, ascended the rocky steps, and buzzed back to our apartment on bi-directional roads. 

[ Captions: snorkel dork and snorkel goddess.]

We decided to find an ATM and with draw some more cash, we discovered that credit cards were not accepted at as many places as we were led to believe in the research phase of this trip. If you are spending a lot of money on a meal or a vehicle rental, yes. If you are getting small items, groceries or authentic meals, not so much.

Swiss dinner was a little electric grill on your table with a plate of meats and vegetables that you heat up on top. No oils or spices were provided but he gimmick was that there is a mini pan that you use to heat up a slice of cheese by placing it in a slot under the griddle. Then you can pour hot cheese on your vegetables. We tried to be good sports every time they came to our table and tried to remind us how much fun we were having.  It was just find and the ingredients were good but it was hot already without a glowing stove in front of you and if I'm going to cook, I sort of feel like I should clean up too.

After dinner we sat at the bar and we were joined by Roland, the other co-owner of the establishment. He talked about how he came here. He was Dutch but got tired of how judgmental Dutch people were and he moved to Switzerland where he met his wife Irene and they came here because the Swiss were not much better than the Dutch. And now the island is full of Dutch people who took their attitudes with them. He also advised us on tomorrow's adventure and another authentic restaurant on the windy side of the island near one of he nicest coral reefs accessible from shore.