Monday, July 7, 2008

The Battle Is Not Over

Two Pablo pics from Polly's archives. Both were taken last Monday the La Brea Tar Pits. This is one of Pablo's fave spots to go and adventure with Polly.
The positive and healing energy from YOU, our army of supporters, proved to work for phase one: the big tumor on Pablo's right kidney is DEAD! We are most grateful. So grateful, that we are making a plea to all of you to keep the up the intensity. Why?

Simple: the battle is not over!

The next six weeks of treatment MUST do the trick to shrink the tumors that have planted themselves on the most critical part of Pablo's kidneys. In layman's terms, the tumors have taken up residence on top of the collecting area, the part that collects waste that flows into the ureter down to the bladder.

Tuesday is the first day of the next phase of our battle.

Dr. Leo Mascarenhas, whom Pablo endearingly refers to as 'Mr. Mascarenhas,' is thinking about our exact strategy, and we will have more to report after we meet with him on Tuesday.

What we do know is that a third chemo drug will be introduced into our little boy's body. He will now be receiving Doxorubicin. This drug is red (notable cos all the others so far are either clear or yellow). It's the first one we've come across that has a nickname: Red Devil. And, like the Castelaz family bloodline, the heritage of this red devil began in northern Italy, at the Farmitalia Reseach Labratories in Milan. Our family emigrated from Trentino. The exact origins of Doxorubicin can be traced back to soil cultures taken on the grounds of Castel del Monte, a 13th Century castle in Apulia, Italy.

Even though that big nasty tumor responded well to the previous treatment, Drs. Mascarenhas/Stein feel that upping the intensity of the treatment in the coming six weeks will give Pablo the best chance at hitting the next goal: for both tumors to shrink considerably, and pull away from the kidneys.

We are ONLY focused on the death and dying, shrinking and shirking of those nasty tumors. Some of us need to know what we are fighting against. So, for those of you (like us) who need all the details in order to put up your best visualization or intention, the reality is, if those tumors don't up and leave–at least enough for Pablo to retain a good part in one or both of his kidneys–Pablo could lose both of his kidneys.

So, prayer warriors, your beautiful work up to this point is working, now let's keep it steady and continue to hold Pablo in the light. He will win with the assistance of all of us!

XO,

Jo Ann and Jeff

Saturday, July 5, 2008

WE. ARE. OUTTA. HERE!

Pablo grabbed my computer and took this pic of himself, with no prompting from anyone. Do you think he's happy to be outta here?

Hi everyone!

WE ARE OUTTA HERE!

Around 11:55 a.m., Pablo called out 'Bombs away' and Jo Ann and her mom Patricia got him on the toilet faster than a tick on a hound dawg.

By late afternoon, Pablo was on his second walk around the sixth floor, and looking stronger and more sure-footed than ever. Polly, Pablo, Jo Ann and I were in the middle of a mean game of Uno when our nurse, Darcy, and the on-duty surgury fellow, Dr. Williams, rolled up on us. One of them said, 'OK, Pablo, you're ready to go home!'

We were headed back to our room in no time.

Darcy de-accessed Pablo's port. She is from Platteville, Wisconsin. I noticed her accent when she started this morning at 6 a.m. I wasn't in the head space at that hour to reminisce about the homeland. Jo Ann picked up the accent as well. While Darcy was removing all Pablo's lines and ports and tape and stuff, Darcy filled us in on her schooling in Appleton, WI. That's also known as the hometown of Harry Houdini. Darcy works with a traveling nurse service, and has gone all over the U.S. working at different hospitals, and we were lucky enough to meet her today.

Dr. Williams, the surgery fellow, pulled the string-thin Novocaine line out of the center of his belly. Imagine a single strand of angelhair pasta inserted through the tiniest hole in the center of his abs. Fascinating. He didn't feel a thing. She was skilled and compassionate–so much so that Pablo contemplated his naval–literally–the entire time she was removing the Novo-string.

The ladies have packed the room while I've been typing (I know, what a jerk I am!). Now it's my job to get our bags, pillows, paintings, photos, food, etc. down to the cars. Guess I better get to work!

Next post will be from home.

Friday, July 4, 2008

Everybody Hurts, Everybody Farts

Friday started with Pablo waking me up and saying he had to go number two. Big news. The kind of Fourth of July fireworks that'll get us a one-way ticket outta here. It was a false alarm, but good news anyway. We were headed in the right direction.

Flash forward to 10:30 p.m. Friday. Pablo had just fallen asleep. I smelled the other kind of big news the docs want to know about after surgery. Yes, like brother Shinta Cho said: Everybody Farts. You know the cliche: to the surgeons, the first sign of recovery in a patient is a few cheek-slappers flyin' out from under the sheets.

Dr. Mary Austin, Dr. Stein's fellow, came in this morning. She says Pablo looks great, the incision looks great, and if he can have an intestino circolazione, we're outta here this afternoon. Man, we've never prayed for poop before. But today's the day we startin. Dr. Austin is who broke the cancer news to us down in the ER in the early morning hours of 18 May. We love seeing her. She is sharp, Southern (from Nashville I believe), sweet–and a diehard cyclist! Pablo was asleep

Moving on...

You know, Michael Stipe's not the only skinny bald guy who gets to say Everybody Hurts. For the past two days, Pablo's version of that song has been 'Every Bump Hurts.' This popped into my head yesterday afternoon. As we got Pablo up and out of bed for a couple walks and a couple mean rounds of Uno, he constantly screamed 'my bump huuuuuurts!'It definitely does. For a kid who's never felt any major pain in his life, and who can take a pretty serious fall and get up and keep running, a gash in the abdomen is a serious blow.

As the day wore on, Pablo was maneuvering with more agility. He hasn't gotten out of bed this morning. That's the next goal.

Jo Ann's here, and I'm gonna run home for a shower.

Thursday, July 3, 2008

Pablo And A Day Of Firsts

It's been an interesting day. Pablo turned five a week ago. By this age, we aren't expecting a lot of firsts. But we are now a cancer fighting family, and the word expectation has a different meaning for us than it did seven weeks ago.

Today has been filled with a bunch of firsts:

• Helping Pablo deal with the first real physical pain he's ever experienced

• Seeing Pablo's normally bright, expressive face hanging blankly, and his normally crystal-clear eyes hazed over from Novocaine, Morphine and Vicodin

• Helping Pablo endure that pain as he sits up in bed and sits in a chair (he has to sit upright 60-90 minutes a day to help his lungs recover from the collapsing effects of anesthesia).

• Pablo staring at us with lazer eyes and screaming "Don't touch my body!" when we try to help him (he is normally very huggy/snuggly/affectionate).

• Feeling the 'marathon' aspect of Pablo's cancer treatment - ie, even though everything is going well, we realize we are at, like, mile marker 4, even though it feels like we cruising thru mile 12

All that said, Pablo IS doing well. We had a breakthrough just now. Getting him to move from the chair to bed took 20 or 30 minutes, but he DID IT! He verbally expressed his fear, and how bad his tummy hurts when he moves. And then, with some visualization culled from our cycling adventures and breathing he learned from Ananta's yoga classes at Walther, HE WALKED THROUGH THE PAIN!

The relief in his eyes was worth enduring the pain of seeing him in pain.

Goodnight everybody.

Fireworks are illegal.  If you live in LA, so is driving while holding a cell phone to your ear.

Wednesday, July 2, 2008

We Are In A Room And Winding Down For The Night

Pablo isn't in the mood for photos, so you'll have to settle for Papa and Uncle Dean.

We got a room. Pablo is still dazed and confused, but doing well. The room has a VCR. Being that Pablo was born in 2003, he has no clue what a 'VHS tape' is. Love that! When I explained to him that the six DVDs he brought wouldn't play because his room had this older machine, he said, "Nana has that kind of a–thing–at her house." A huge bonus is that the nurse's station has his current fave 'Anastasia.' We only have it on AppleTV, cos it's not out on DVD yet.

We expected to be with the cancer crowd this week, but the fourth floor soft tumor unit is fully booked. No room for little Pabi. So we are in the 1960s-era physical rehab floor. Note the bubble-icious sky roof in the photo above. It's a whollllllle different scene up here. Noisy. Every kid has a dozen family members coming by. Many of these kids have been here for weeks or months, getting intensive rehab for gnarly injuries.

It's kind of nice up here in many ways. But we'll be happy when/if the fourth floor calls to say they've got a bed for Pablo. We like the quiet of that unit. Plus, all of our docs and fellows are roaming that floor all the time, so we get more face time with them.

So, Jo Ann and I are working the charge nurse to get us moved to floor four asap. Tomorrow would be the soonest.

THE BIG TUMOR IS DEAD!

GREAT NEWS!!!!!!

Big Boyee is DEAD!
Big Boyee is DEAD!
Big Boyee is DEAD!

Dr. Stein biopsied the big tumor (right side). It is completely dead!!!!! This means the chemo is working. This means cancer is losing the battle! This means PABLO IS WINNING!

PABLO IS WINNING!

Dr. Mascarenhas just came down to tell us the news. He was on the phone with Dr. Stein during the operation. He said they may biopsy other pieces of the tumor, just to be sure, but that Dr. Stein's assessment is that the entire thing looks the same.

Here's what's gonna happen: Dr. Stein is gonna sew him up, leaving the tumor right where it is.

Sounds crazy, right? Counterintuitive is the way we are lookin at it. These doctors know their s**t, and their biggest priority is to preserve Pablo's kidney at all costs.

So, the goal with zapping the tumor with another six week round of chemo is to see if it will shrink away from the kidney. That would allow Dr. Stein to slice it off the kidney, and leave behind a healthy kidney.

In an instant, we are playing a game of inches - a helluva lot more comforting than the hazy game of miles we were playin prior to now.

Dr. Stein will get another bite at the apple on 19 August. OK, possibly not the best choice of metaphor. You get what I mean.  

We now have Mile Marker #2 in this marathon.

This is all we know at the moment. Lots more deets to come, for sure.

Pablo Is Going Into The Operating Theater NOW!

He's getting the feel-good medicine as I write this. Jo Ann is holding him. We'll give him one last hug and kiss as he falls away from this nutty room. And then he'll be in the good hands of Dr. Stein and his team.....

More updates as we go.

Funny Story From The Car Ride To CHLA

Pablo can't eat or drink til after surgery. To put a finer point on it, he can drink clear liquids. In our house that means water or apple juice-two things Pablo loves to pound down any day of the week. Except today. I swear, he just WANTS OJ and a red fruit popsicle just cos he CAN'T have it. I would! Who wouldn't?

A few minutes ago, on the way to CHLA, we drove by Intelligentsia, our local caffeine injection emporium. We always stop there, or the Starbucks in the Vons grocery adjacent to CHLA. Couldn't stop at either. Pablo would freak the funk to see us ordering delicious, sugary drinks in front of him, knowing that he'd be on the outside looking in.

So, I came up with a workaround: get someone to BRING us coffee-which could be consumed out of Pablo's sight-ASAP!

Adam Harrison from Dangerbird had just IMed me and I knew he was en route to Hollywood.

Using good ol' Blackberry Messenger, the best way to communicate when you absolutely gotta have something NOW, I got Adam to change his destination to Starbucks on Sunset and St. Andrews, then CHLA.

Then came the hard part: getting drink orders from Jo Ann and Dean without triggering Pablo. I spelled the order inquiries. They spelled out their orders in response.

Jo Ann spelled out "I C E D. L A T T E."

Dean dropped these letters: "I C E D. A M E R."

Suddenly, Pablo pipes up and says, "I'll have a hot choclate!"

Our Starbucks spelling bee plan was a bust. But, daaaaamn was that a funny and precious moment!

What's even funnier is that the admitting rep just asked Jo Ann if I was the patient. "I was going to ask if he could sign for himself," she said.

Laugh now, laugh hard, make all the 'he's a goofball, so that figures' comments you want lol! I deserve it, I'm sure!

Tuesday, July 1, 2008

SURGERY SET FOR NOON WEDNESDAY

The human kidney. The tumors on both of Pablo's kidneys have grown over the fleshy-colored core of the kidney. In layman's terms, I call that area the 'central drain.' Read on to learn how this fits into Pablo's scenario.

Surgery is set for NOON WEDNESDAY.

We need everyone to send light and love directly to Childrens Hospital Los Angeles at that time. Pass the word to everyone you can. We ask that you stop what you are doing, and bring Pablo into your consciousness. That is all we can ask of you. And it's a big thing to us. We believe–and have seen–the power of intention work in our lives time and time again.

Wednesday at noon is game time, and we need you on our team.

Everyone wants to know the details. What's going to happen when they open up his little tummy tomorrow? The answer is, there are so many variables, it's hard to get into it all. This isn't a Hollywood war movie moment where "we're gonna go in and knock back the Hun." We wish it were. I'd have rented Robert Duvall's costume from 'Apocalypse Now!' for the occasion.

In broad strokes, Dr. Stein's options range from doing a quick biopsy on the right side, tossing the specimens to the pathologist on his team, and, based on what he sees, proceed from there. This is the ultimate audible play. Wilms' Tumors fall into two buckets: good and bad. Just like Coke and Pepsi. Darth and Luke. Metallica and Megadeth. If the biopsy proves 'favorable histology,' Dr. Stein will take one course. If it is the bad guys, there's a totally different protocol altogether.

The long and short of it is that there are a few concrete facts the docs can see in Pablo's CT scan:

• The tumors on both sides have grown into the kidney's "central drain" area. This complicates things, cos that is how pee pee gets to the urological tract. Dr. Stein can deal with this with a standard surgical practice, but it makes it different than simply removing a tumor that has grown on a non-essential part of the kidney.

• The left tumor has stagnant growth. Great news.

• The right tumor (Big Boyee) appears to be in a state of necrosis, which means cells are dying, and are hanging around in the sac that is attached to the kidney. Technically, Mr Righty has grown about 5%, but the docs say that this is considered 'flat' in their view.

• They see no effect on Pablo's lungs or lymph nodes. More great news.

• Overall, the docs feel the chemo has done some work. The greatest news.

This will all make more sense when I can lay out a report of what DID happen sometime late Wednesday.

Please be with us tomorrow.

Here are the key times:

• Check in at surgery pre-op desk at 9 or 9:30 a.m.

• Pablo goes under at noon

• We wait in the surgery waiting room, and can take a restaurant-style beeper if we want to take a walk

• After Pablo wakes up, he will be admitted

• Length of our stay is dependent on the procedure Dr. Stein pulls off in the operating theater.

HERE'S A PLAY-BY-PLAY OF OUR DAY TODAY

We spent all day at CHLA Oncology Clinic. 7:45 a.m. to about 4 p.m. Pablo, Jo Ann and I met with Dr. Stein, our surgeon. Then Dr. Mascarenhas, our oncologist, joined the meeting. Each of them popped into our room at least one other time later in the day to check in on Pablo, and us. Jo Ann and I feel secure and sorted when we have a second or third opportunity to chat with the docs. Some other visitors joined us in the room today as well: Polly, of course, AND Nana and Boo arrived yesterday from Houston, and Uncle Dean came in from Milwaukee today.

Throughout the day, Pablo had all kinds of pre-op observations, vitals, and a blood transfusion. He now has a pint of his Papa's blood coursing through his veins. I joked with him at dinner that now he can read me a book tonight.

Just before the blood bag was connected to his port, Pablo's temp shot up, and the blood had to be put on hold. It's not ideal to do a transfusion with a fever in the recipient. With a four-hour clock running on the blood he was about to receive, the medical team drew a blood sample from him (fever can indicate infection), and knocked back the heat with an oral dose of Tylenol.

After an hour or so, the fever went down a bit, and the blood line was connected to Pablo, and for the first time in his life, he took someone else's blood into his body.

It's 4 A.M., I'm Eating Waffles

A note to parents: this post is not intended for children.

Tossing and turning since 10 p.m., nothing seems to work. Pablo snoring away next to me, the daily end of life has not come to me. I cannot fall asleep. This happens every Monday night.

Tonight, as Pablo fell asleep on me in the fort, his breathing deepened, and he nestled his body into mine. This is my favorite part of being a parent. He needs me. He loves me. I am his father, and I am here to do my simple part of just being here. Despite the simple harmony of that moment, the Monday Night Current of Anxiety rose in me.

After Pablo fell asleep, I lifted him, laid him on his pillow, climbed out of the fort, and went downstairs. I could not fall asleep. Jo Ann was doing her Novena, so I went to Grady's room, and caught up on email, thinking that'd get me in the sleep zone. It didn't. But I went upstairs, climbed into the fort and tried to force myself to sleep. I rose again, this time heading for the kitchen. I needed some Elmo-Os.

I've climbed 10,000 feet on my bike in the past three days. My legs ache, feel heavy. When I push that hard on the bike, I often wake up in the middle of the night and have to ingest some calories. It's not hunger pains specifically that wake me–it's an overall soul coughing that radiates from the insides of my bones. It's quite satisfying, really, when it's not attached to a larger event like it is now. It sure beats waking up with a hangover, which was my lot in life prior to seven years ago. Usually, the eating calms me down, and I easily fall back to sleep. Not tonight.

As I continued to search for the magic position of my body, the blanket, the pillow, I kept telling myself, 'It's like I just got back from London, and have to wake up early LA-time for an important appointment. You're going to be OK in the surgeon meeting tomorrow.' When that distraction wore off, my mind dropped down to the truly tough stuff: real, bona fide fear.

It starts with something simple, like, 'Why is this happening?' And escalates to: 'If I can just envision Pablo graduating high school, that will be a good sign. Then I'll be able to fall asleep.'

This is where it gets really tough for me. And I need to put my hand up at this point and tell you that what lies below is heavy material. If you aren't able to go there, stop reading now. If you are OK to read about how the experience with Pablo lines up with past events in my life, read on.

Let me start this section by reminding you (and me!) that the Pablog has one purpose–to document our family's experience on this unexpected journey. The full experience.

Because Jo Ann has a different process than me, the blog has been mostly about my experience, or at least my interpretation of our family experience. She writes when it comes to her. All good. It works for us.

So, some days and weeks in Pablogland have been filled with reports of good, even funny stuff. For the past week, I have not been 'good' or 'funny.' Far from it. Anger has been my constant companion. I know what anger does: it mimics control, something I do not have a lot of at the moment. My anger leads to drama, and drama fills up time that might otherwise be idle, or reserved for inward reflection. But the pain is too great to crave inward reflection. So staying in anger has a double payoff: control and the general anesthesia of drama.

I am human, and will make more mistakes in life than any blog could hold, so I have no problem revealing this to the Pablog world. It's just the truth.

Another truth is that there is no script for this. When I first heard the words 'Pablo' and 'cancer' in the same sentence, I thought I could make it through OK because of my cancer experience with my older brother Scott. I guess I did think that that was my template, my script. He was not just my older brother. He was my idol, my guide in life, a father to me and my little brother Dean. Taught us about music, art, architecture, food, critical thinking, spirituality, everything. Get what I'm describing? Scott nurtured us, period. And the fact that he was our brother, not a parent, made his guidance sort of the ultimate 'Stand By Me' journey through life. Bittersweet, robust, authentic. We were constantly in search of the purest stuff life had to offer. I would give anything to have him sitting next to me right now. Anything except Pablo. Anything except Grady. Anything except Jo Ann.

I would exchange the past four years of Scott being gone from this earth for four years of me being gone.

Jo Ann and Grady have lived this with me. As a family, we have gone through ups and downs based on my deep sadness around the loss of Scott. Pablo has grown up seeing me weep in the middle of Morning Becomes Eclectic (a song reminds me of Scott). And Jo Ann has seen me worry about every dull pain in my body, fearing cancer. I even paid to have a full body MRI five years ago. Since then, I have had this nagging notion that my day was coming. I had no idea it'd be my son and not me.

I have walked around for the past five years thinking that it'd be me who would be diagnosed with cancer. Why did it skip me, and go to my son? Why does my little boy, so sweet and precious and funny and bombastic, have to carry this fucked up genetic mutation? Why is it him who has the port in his chest? Why does he even know what a port is?

Four years ago, Scott was dying. Literally, he was at the end of life. It was his emphatic wish to pass onto the next life in the comfort of his Chicago townhouse. For weeks we nursed him, right there in his living room. The sights, the sounds, the smell. The hospice nurses and doctors. The middle-of-the-night oral Morphine injections. Then, as he got closer and closer, the middle-of-the night hallucinations. Scott's subconscious was unraveling, as it does with humans. One night, he looked at me with lazer eyes. My arms around him, he had no idea who I was, but was sure that I was out to hurt him. "Get away from me," he said.

Finally, after a few weeks of this, we convinced him to retreat to Northwestern Memorial Hospital, just a mile down Michigan Avenue. Isabella, his daughter, was just three at the time. It was impossibly difficult to see her seeing her father die–in the living room. She was scared. And Scott's wife, Susan, could not take it. There was no easy angle in the scenario.

Scott and Susan's dear friend Father Chuck, who'd married them and baptized Isabella, drove us to the hospital. It took us five hours to get him to rise out of his chair. He did not want to go. I half-carried him down the stairs. The other half was him sort of sliding down on his butt. The entire way down, Scott wept in a way I had never heard, and have not heard since. Open-soul weeping. At that moment, I remember thinking, 'Irony is dead for me. Humor is dead for me.' And, for a long time, it was.

As we were pulling out of Scott's neighborhood, he asked Fr. Chuck to make one more loop around the hood. Cruising past his house, Scott asked Fr. Chuck to stop. Sitting in front of the house, Scott gazed at his front step one last time, clearly and squarely, with purpose. "That's where my little girl plays," he said. A beat. Then, "Let's go."

I had to tell you that story. There is no explanation. It just came out of my fingers and I typed. It was burning in the flames of my fear, anger, anxiety. It is related to Pablo, but mostly just in my head. Scott and Pablo are two different people. Pablo's cancer is wildly different from what Scott had. I am not confused about that, or in any way mixing metaphors. All I know is I feel slightly better now.

But when you get hit by a bus a second time, it still hurts like hell. And it does not let up or let go. It makes me want to eat Elmo-Os at 1:30 a.m. It makes me want to eat frozen waffles with Trader Joe's real maple syrup at 4 a.m. (see picture above).

I have been through a lot in my life. Like you. And so I know only one thing: I will endure. WE will endure. Love is real, and healing, and is the stuff that life runs on. You have given me and my entire family more love than we know what to do with.

As the sun rises over Los Angeles this morning, I am tired. And, knowing that by hitting the PUBLISH POST button in a second, I am letting of all the shit that's kept me up tonight. Being tired is nothing compared to what Pablo is going through. And I don't need a port to get the caffeine where it needs to be.

If you have read this far, I thank you. More jokes soon, I promise.

xo
jeff