Tuesday, March 31, 2020

Staying in Place

This morning we were informed that the Government of Mexico has imposed some new restrictions on the population.  As of tomorrow, and for a month, all restaurants will be closed completely.   We have a favorite place for breakfast run by a young entrepreneur and talked to him this morning about what he will do.  He has put a lot of time and energy into his place, called Rustica.   It has an open and airy feeling.  But he will be closed, and all of his employees will be furloughed for a month. That got me to thinking.

In my lifetime there have been several stay in place situations.   The first was the Cuban Missile Crisis in October 1962.  The crisis had the nation transfixed for almost two weeks.   I do not remember us being sequestered but I do remember the pall that overtook the nation.  John Scali, who was an ABC reporter, intervened by meeting with the KGB station chief in DC and then things started to move.   The Crisis had built from the prior year's invasion at the Bay of Pigs.  And tensions began to grow.   There were a couple of good books on the crisis, all about the informal channels used to defuse the crisis.   When we moved to DC one of our favorite restaurants was a Chinese place on upper Wisconsin where a lot of the negotiations to defuse the crisis took place.   Peking had two qualities.  First, they had superb Kung Pao Chicken!  Second, they had a waitress whose name I think was O'Hara, who had worked for the restaurant for a long time.  All of the other staff was Chinese but she was not.  She was  funny and dedicated to the place.

The second  I remember was on the Friday that JFK was assassinated.   On that Friday, the news leaked out slowly.  First we learned that JFK had been shot and the soon after that he had died.  School was dismissed early - I was a senior at Palos Verdes.   We then spent the entire weekend glued to the TV.   I remember clearly the live coverage of the transfer of Oswald in the Dallas Jail and the response of the news people when Jack Ruby shot Oswald.  About two decades later I was teaching at USC and was trying to explain society defining events - I mentioned that all people remember where they were when JFK was assassinated.  One graduate student raised his hand and said "I don't, I was not born then."

The odd thing about the JFK weekend was that there was no internet.  So while there was some phone contact, we were isolated, almost completely.  Kennedy's funeral was on the 25th (or three days after Dallas) so it became a continuous event.

My siblings and I have tried to figure out what our parents did in 1918 (My mom was 6 and my dad 4) but I do not think either of them talked much about their experience.   1918 was a major pandemic. The CDC said that one third of the world's population was infected with the influenza and that almost 700,000 Americans died.  That is on a base of just over 100 million people. So the pandemic was huge for the year.  The public health officials at the time did some isolation and staying in place.   But remember medicine was pretty basic at that time.  Almost all of the modern drugs we take for granted were not invented by then.


The third that is prominent in my memory is 9/11.  I happened to be in Mexico City at the time teaching a course at Universidad AnĂ¡huac del Sur.  My routine was to go out in the morning before going to campus and run in a park with the bull fighters.  I came back to the professor's house and the property manager was watching TV.  It kept showing the collapse of one of the twin towers.  I asked in my very limited Spanish was it real or a video - and he looked at me very grim and said it was real.  I got to campus quickly.  The media staff was pulling down all the video they could, thinking it would produce many teachable moments.   About an hour after I arrived the Rector, Fr. Dermot McCluskey, gave a homily which was amazing.  Even with my primitive Spanish I could understand his message about the reality of what had just happened.

The City quickly shut down.  After I caught my breath I called my wife and my daughter and reassured them and then found things to do.  In that evening we went out to dinner and the CNN news loop was replaying the story for the 1000th time - one patron asked to turn off the TV, and when they did everyone cheered.

On that weekend I went to Xalapa with a university staffer and his cousin for Independence Day weekend.  His cousin got us to stay in a disco until 3 or 4 in the morning.  We got out (I really do hate discos!) and could not find our car.   My friend, who was originally from Veracruz, said lets ask two guys on the street for directions.  The two guys we choose looked like they could not have put together 100 pesos between them.   One had a bottle of Johnny Walker stuffed in his pants and kept offering us a plug.  They got in our car and when we got to the hotel - one of the two looked at me and said (in Spanish) "the loss you think you had did not happen to you". - Tensions for Americans were high there; we had been attacked.  But then he added "It did not happen to you it happened to all of us".  I relaxed and we sat outside the hotel eating street tacos.  I never did accept a plug from the Johnny Walker.

One other thing happened.  I returned to California about two weeks later.   I called United and asked when I should get to the airport for a 6:30 flight.  They said absolutely three hours early (3:30 AM).  I got to the United counter at about 3:25 and it was dark.  The only other people in the line were an elderly couple going to LA to visit their children.   We chatted until the United people arrived about 5:45.

As I have thought about it each of those events had something in common.  They momentarily brought us together as either Americans or as people (in the 9/11 instances).  We threw down all the petty nonsense and began to talk to each other.  What has intrigued me about the Corona situation is that many of the same things seem to be happening now.  In the last two weeks I have used Zoom and Webex (I like Zoom better) to do conference calls.   Last week the university board I chair had one of the most substantive meetings we have had in a long time trying to think about what has changed for us in a project that we have been working on for a couple of years. We need a new campus and we finally got to analyzing what we could afford and what we might be like in a few years.   Higher education is changing quickly.   Last week two independents in California failed.  Neither was surprising but in a long talk with an old friend who has been a remarkable college president he said what we need to look for next is how many students show up in the fall.  Some independents in California have chosen to assist students who have substantial needs and to refund either room and board money or even some tuition payments.  Others have not.  I suspect the ones who recognize they and their students are in the same boat will fare better.

Our parish in Folsom held a social hour last Friday and about 25 families participated - it turned out to be fun.   Our kids introduced us to an APP called HouseParty which is a pretty good video chat capability in real time that also has some features like a trivia contest. There are some new notions of online etiquette which still seem to be working out - but the things are developing rapidly.

We also decided this week to compare and contrast the advice the US Government is offering (come back to the US immediately) versus the advice of my physicians (stay in place in Mexico) we chose to listen to the docs.   We know that Mexico is about to tighten up their already very tight stay in place requirements.  But while some of our friends have made disparaging remarks about the cavalier way Mexicans are reacting to the pandemic the reality is that they are doing very well with staying in place.  The picture to the right is of the Jardin (center square) last Sunday.  Sunday in Mexico is family day and almost all Sundays the Jardin would be packed - not now.

The next steps here are uncertain.   The new order for restaurants in Mexico is for a month and then a reassessment.  In the US the Congress (finally) has passed a stimulus bill - although I will admit that a lot of the things in it are puzzling at best; it is 9.3% of the pre(Corona)-GDP and some of the grants are just pure pork.   The initial jobless claims last week (3 million) are daunting.  And despite the nattering of the left, I agree with the President that we should be looking at safe ways to begin restarting things will all deliberate (and prudent) speed.  There are many experts jabbering but few actually have much useful to say.  I quit reading the market analysts because I think they are not very good guessers - the old joke about economists (they have successfully projected 11 of the last 3 recessions) applies here.

A friend in Palm Springs commended a PBS series from Niall Ferguson on Networks,   He is trying to figure out in our new world how we can re-establish sensible talk - the series is superb and follows up on his book of a couple of years ago (find the series at https://www.pbs.org/wnet/networld/) and the book on Amazon (The Square and the Tower).

Finally, the California governor has been omnipresent in the media.  A good deal of what he has done is fundamentally positive (he is not one of my favorites but I think on the whole he has done well).  Included in his accomplishments has been an order to temporarily lighten licensing requirements for the health professions so as to be able to get an infusion of people like recently retired and just about to graduate students into practice NOW.

I saw my doctor in Mexico this morning to stock up on medicines I take so I can stay here for the next six weeks.  He like he often does, had good advice.  He told us rather than worrying about what might happen take the appropriate precautions (including avoiding social media) and reflect on the wonderful things that have happened in our lives.   He also offered Quinlan a pregnancy test.  It is great to keep a sense of humor!

Saturday, March 21, 2020

Nickels Redux

We arrived in San Miguel, as the last post suggested immediately after I got the all clear from my Sacramento and Stanford doctors.   But when we arrived we found a changed environment.  In the middle of this week I went to my San Miguel doctor (speaks seven languages) to discover whether I could find a resource to deal with the every six weeks port cleaning required for maintenance of the port they inserted to deliver Chemo.  All the doctors said it would be a good precautionary measure to keep the thing in for a while.  Turns out my doc who works with stem cells is fully prepared to deal with that process.  So that was checked off.

But we also got an initial note from the Mayor who imposed the first phase of a set of orders to contain the virus.  He cancelled all public events (that includes all religious observances and all parades) and he suggested the usual wash your hands, social distancing and good food and diet.  When I saw my doctor here he suggested that we establish reasonable distance from social media (which seemed to me the most promising strategy!).

What has amazed me is how the story of Corona developed, here.  When we came into Leon there was a health official scanning temperatures of all arrivals.   But the rest of the city was about normal.   We went out to dinner with some of our oldest friends one night and then went to our parish on the first Sunday we were there.  They immediately announced that would be the last service until the crisis passed.   Our home parish in Folsom was even a bit more ahead - they live streamed the Sunday service on Facebook (https://www.facebook.com/trinityfolsom/videos/241275083693758/).  I am not a fan of Facebook, which I think has helped to degrade pubic dialogue - but this seems like a great idea.
Produce Section of our Market
About a week ago we were in one of our favorite restaurants and just as we finished dinner a gusher started - there were no cabs and we did not have an umbrella.  One of the other patrons suggested UBER - so we dialed in and after only 35 minutes a guy showed up.  The waiters made fun of the APP because when the gusher stopped there were plenty of cabs available.  They kept stopping by our table and looking at the APP.  

In the middle of the week the Mayor jumped things up a step to ask all of the residents to mostly stay at home.  We talked to our maid and said don't come and we will pay you until the emergency subsides.  We also went to La Comer to get supplies - not like in the US.    We've seen the pictures all over the net of empty shelves and regulated lines.  The lines here for Costco are limited but supplies of everything from TP to fresh fruits and vegetables is in normal supply.  No hand sanitizer and no anti-bacterial wipes but everything else is in abundance.

Normal Lines at our Market
When we were in the market today lines were a bit below normal.  Everyone kept their distance but shopping was orderly.   Last Sunday I had heard that one of the markets below us had wipes so I walked down.  There were six packages on the shelf - I chose one.  And then, what are lovingly called San Miguel Swells (An expat with an attitude) scooped up the remaining five.  I asked somewhat malignly - "stocking up before the hoarders?"  She shrieked " That's not funny (it was not meant to be) - this is a health emergency!!!!!!!"  I wondered why she felt entitled to clean the shelves.  

Tonight I went for a normal walk and talked to a couple of restaurant owners both have decided to close down for a couple of weeks.  I expect more of those will come - although I spoke with one owner who said he is remaining open and several others are offering take out.

When SARS hit Mexico, SMA closed the city for a week to 10 days and required all people to stay off the streets - and that was strictly enforced.  As a result the incidence here was reduced over other places in the world.

We thought long and hard about whether to return to California either on our original flight or sooner - but we ended up rejecting that.   For now we will remain in place until income tax day.  There are a couple of reasons.  California looks like it is in the panic mode (do not get me wrong many of the Governor's actions seem justified).  At the same time we have a very good community here.   And then there are the sunsets.   Last night we were sitting on the Sala (Patio) and I caught this picture.  It kind of sums up our place in SMA.   In this complex we have a gate and a pool, a treadmill and free weights and a fridge stocked with food and a wine cellar that could last us for a couple of weeks.  We also have reasonable internet coverage (although right now no landline).  Down the street there is a superb vegetable and fruit market (that also has a butcher).  So even if we are completely confined to quarters - it could be better than returning to Fair Oaks.  Did I tell you our daytime temps are in the low 80s?

We are living in novel times (pun absolutely intended).  What intrigues me about the situation is how thin US society seems to be at the outset - the TP runs are not good indicators and yet I've seen some absolutely amazing responses from families who have organized activities for their kids while at home.  I've also been amazed at innovations like the one above from Trinity Folsom - which immediately organized a way to serve its community without missing a beat.  At the same time I immediately grew tied of what my oldest brother calls media "expects" - what Eric Hoffer used to called "learned ignoramuses" who are ready to spout a network's existing theory about what will happen next.   We've seen again that there are some very good public officials and some bureaucrats who seem to be there to press their agendas. 

In this age of Instant Analysis we want surety. Too bad, it is not going to happen.  What I have admired in the last week has been a couple of researchers who are willing to test the wild-eyed claims of some of the "expects".   The chart at the right shows some demographic differences between Italy and the US - and offers at least one potential hypothesis why Italy has had such a huge outbreak and disastrous results.   Thinking more about these population curves might offer a more targeted response to the immediate threat.
A second promising approach appeared this week from two university researchers tried to do some "curve fitting" on the data that we have on how the virus grows and seem to suggest that the claims of exponential growth are overblown.  (https://doi.org/10.1101/2020.02.16.20023820. )  A follow up study by three Italian researchers - published yesterday - also brings into question the apocalyptic yammering of some of those expects. 

One thing is for certain - we are going to have to be creative to respond to the threat(s) not just to 19 but to the threats of living in a complex world. In my mind that does not include figuring which bureaucracy screwed up.   We can assess blame after the virus is better contained.






Tuesday, March 10, 2020

Estoy en casa and the Precautionary Principle

Last night we flew from LAX to BJX and arrived in San Miguel very late at night.  It is a sign of my continuing positive results.  No-one who knows me would be surprised by this trip.  On February 24th, I saw my Stanford team and they offered a high five.  (And before the Coronavirus panic the lead doctor shook my hand).  We then went back to Sacramento and last Thursday had a check with my Sacramento team who pronounced the same result. My main doctor  shook hands and then reminded me to wash mine and he would wash his. The redundancy of having two concurrent opinions is one which I like.

We spent a couple of delightful days with our Daughter and her family.  On Sunday she ran the LA Marathon and took 38 minutes off her former time!  I must admit I am not surprised at her performance - proud yes, but amazed no.  Before we left we had the chance to see our younger grandson do an exhibition game in Little League.  Needless to say Buffalo Consulting would have preferred to sponsor the Dodgers but the Cubbies are a good second choice. Quinlan was thrilled.  Our oldest granddaughter is starting Softball in a rec league.  So in many ways the weekend was filled with contests.

I have been struck over the last week at the responses of all of us have had to Corona19.  I am in no way seeking to diminish the nature of the disease.  Like other viruses it can be deadly and it may prove worse than the initial data suggests.  But the reactions from the media on this problem have been just plain horrid.   A week ago I was with a friend who is the former dean of the UC Berkeley School of Public Health and he, like a good doctor that he is, was trying to assess the potential impact of this new strain of a virus.  This is a new strain of a virus and we should work to better understand it.  But PLEASE!  Let's put this in a more realistic construct.

There is some pretty clear evidence that the Chinese screwed this up royally - would you expect any less of a totalitarian regime?  And the cautions offered by the saner public health officials are appropriate - WASH YOUR HANDS (Fortunately that was something that I learnt in my recent medical adventures).  For people like me, avoid crowds and sneezy kids.  But the Main Stream Media has presented this without setting any context.  There is also some evidence that the reproducibility of this virus is higher than other viruses where a Corona infected person may infect 2-2.5 people while a flu victim potentially infects 1.3 people.  But we should not go overboard.

It is odd flying at this time.  A week ago I flew with our oldest grandson to look at a college in Oregon.  In the first row was the UCD Davis Women's Lacrosse coach handing out wipes.  The Southwest flight attendants said their planes were the cleanest they have ever been.  Mason turned out to not like the place he went - which is a selective liberal arts college - and he ended up choosing Western Oregon - which I hope will be a good fit.  Football is part of the equation, but so is need. The College was Division III and Western Oregon is Division II.  The coach for Western Oregon, surprisingly to me, seemed more interested in Mason's academic focus than the head coach for the liberal arts college.  The college we visited offered him a package which left $16,000 per year (for a kid who is rated as full need) to cover through loans.  That seemed a bit extreme.  Western Oregon, which can offer athletic scholarships, offered him a full ride.

But getting back to the Corona virus - our reactions have been over the top.  “In the U.S., it’s really a fear based on media and this being something new,” Dr. Jennifer Lighter, hospital epidemiologist at NYU Langone Health, said of the new coronavirus. “When in reality, people can take measures to protect themselves against the flu, which is here and prevalent and has already killed 10,000 people.”


The chart on the right shows the impact of the ordinary flu over the last several years.   You don't see the MSM doing cartwheels on the dangers of flu.  Corona becomes the panic de jour.  I wonder how the Mexican alternative to Coors is doing in sales.

In the last 10 days we have lived through a set of panic related events all related to the murmurs on Corona - in the Stock Markets (with huge swings in the Dow and other averages); in surge buying of hand sanitizers (I need to get my supply before the hoarders) and in a host of closings of major events (some of those might even be good cautions).

For me, this gets back to economics (surprise!).   There is something called the Precautionary Principle which posits in the extreme that we should do nothing unless we can be sure the results will not be bad.   A good deal of life is uncertain but this wonderful notion argues we need to anticipate harm before it occurs (an ounce of prevention) but then the principle is extended to limit our actions unless we can be sure of results.  What tommyrot!

Last night as we were arriving into Leon a public health official pointed a big yellow scanner at each of the arriving passengers.  I wondered what he was doing.  It turns out that it can do a quick check of whether an arriving passenger has a fever.  If they do, they go for secondary screening.  That kind of precaution does not bother me.   

This is probably the last in the series of posts for this blog.  With the successful results there is not much to report.  Thanks for all the support during my ordeal.  As I said in an earlier post, I cannot express how much those expressions meant to me.

I've started on a new project.  For Christmas, my daughter Emily gave me something called Storyworth - which asks you to write from a prompt once a week for 52 weeks.  The topics have been interesting (What were your parents like; What did you read as a kid; Why did you choose the field you did in graduate study; What did you do for family vacations?).  If you have interest in reading any of them I can send them to you.   Just send me an email.  Her motives might be twofold.   First, it might prompt me to get off my hind end and do the book I mentioned earlier.  Second, it will present a lot of information about me.   At the end of the year - Storyworth publishes these in a book form.   So far the editing software they use is primitive.  But the project has allowed me to think about a lot of issues I had not thought about in a long time.


Friday, February 7, 2020

SEVENTH INNING STRETCH


Many photographers spend a lot of time with sunsets and very little time with sunrises.  That may mean that you are more ready to take a picture in the late afternoon. But this post has three pictures where the sun is a prominent player - it fits the story.  You can guess which ones, if any, are sunrises.

Last Friday I did another Pet Scan in Sacramento.  The process has become almost routine - you fast for six hours, then get injected with a radioactive sugar which is then viewed using the equipment.  Sugars attach to the cancer cells so it gives indicators of where the nasties are.  Pet Scans involve sitting in a two stage tube for about 40 minutes.  I still have the problems of not liking small spaces.   But these are much better than Cat Scans which are noisy and a bit more confining.  So before I go in the tube I take a drug to mellow me out.

I waited the weekend for the results, in expectation but not on pins and needles(although I will confess that I had one acupuncture treatment on Wednesday).

This morning at about 6:30 the results were released.  And thankfully they were pretty clear - The Findings are Consistent with a Complete Response.   I went in for what was to be my seventh infusion this morning but before I started I consulted with my doctor.  He said, go ahead with the Ritoxin and then STOP.

We discussed next steps.  I will see my Stanford doctor at the end of the month.  There are two ways to treat people in my condition - oddly they are at least partially counterintuitive.  Persons with low grade lymphomas are put on a once every two months infusion of Ritoxin - to assure that the little buggers do not come back for the first two years.  With higher grades of the disease once you reach the cycle of infusions - in my case the original was 6 - you stop and then get periodically checked.

After a couple of conversations with my lead doctor, we decided that the seventh infusion would be my last for now and would then decide before we go back to Mexico whether the Ritoxin prophylactic was indicated.   


In any event I get to do a similar routine to my one after my melanoma in 1997 - when I was pronounced "clear" at that time, my surgeon said you and I will become good friends because I will check you lots in the first few years and then once every six months.   Rechecks involve flushing the port which is infused with a saline solution and Heparin to keep the port clear about every six weeks.

If I have learned three things from this experience they are pretty simple.  Wednesday in a discussion with my acupuncturist he said he had three kinds of cancer patients.  The first come in angry and stay angry.  The second come in and say woe is me.  The third understand that while many behaviors can lead the way to cancer, a lot of cancers are part of life and the older you get the greater the chance of contracting it (Something Siddhartha Mukherjee  proposed  in  The Emperor of All Malladies) and you deal with it.  
He commented  that the third group were the most likely to successfully survive the 
challenges of this disease.

A second thing I learned was the importance of a support network.  Mine has been 
exceptional - in all sorts of very special ways.   From a bunch of you checking in 
periodically and allowing me to vent a bit - to others who helped me think about 
options, to a great group of medical personnel.  Gratitude is an over used word but don't 
ever think that I am not enormously grateful for all of those things and more.

A third learning is based on the power of prayer.  I have had the benefit of many different 
faith communities intercessing in my behalf.  Even if you do not believe in a God, those 
actions help the patient center on healing.  

Life is a process not an event, so I expect that there will be future chapters on this story 
but at this point, I want to offer my sincerest form of thanks to all of you who have 
helped me through this.  Cancer is sneaky.  So getting out of the woods takes a couple of
steps.  The monitor you closely for about two years.  If things go well  they decrease 
that monitoring for three more.  Finally, at five years you go back into the 
general population - at least for this disease.

We will go back to SMA in March for a very short trip, and then depending on 
whether  this very good news continues, we want to be back for a slightly longer 
term in the Summer and then again in the Fall for an extended period.









Thursday, January 16, 2020

Tarantella Medicine

It ha been a busy week culminating today with my sixth infusion.  I get accused of having odd titles to let me explain a bit on this one.   In both Italian and Irish music the meter on many tunes is six beats per measure.  So you have 6/4 and 6/8 signatures.  As you will see below I may go through two more infusions before being released.  That depends on a pet scan which will be done in the next two weeks.  I am quite comfortable with that result.

The week started with a visit from Emily and her two girls.  We went to the Crocker - which is actually a good art museum.  They had an extra week off and we had a good visit.  The kindergartener (Dylan) spent a fair amount of time on her new iPad doing numbers puzzles where you move blocks to form sums.  The older one is an avid reader (gene trait partially from Q). She read a long book on the trip up and while she was here.  Both of those kids have a great facility with language. We also went to the California Indian Museum, which is disappointing; small and often neglected compared to Sutter’s Fort, which is adjacent.

The picture at the side is of Sloane and Dylan at the Crocker. For her ninth birthday she invited one friend to go to the Norton Simon to sketch and then go to a French dinner. Both kids have  propensity to art (not from my gene pool).

Emily had to move out on Wednesday to make space for a visit from my oldest friend in Mexico.  Fr. Dermot and I have been friends for almost 30 years.  He was president at two universities and had a knack for building places.  He is now semi- retired doing some parish work and doing seminars on ethics.  On Tuesday night, before he departed early (actually very early) the next morning we had four friends over for an early dinner.

The Sunday before, we had dinner with Peter and Jessica and the 3 kids.  They are very different from Emily’s kids although both groups are well mannered.  Mason is caught up in deciding about colleges - with lots of options.  He is looking at the choices with care and he has some good choices.  His tribe was recently certified so he is likely to be eligible for some Native American grants (unlike one presidential candidate - he is one quarter Chippewa Cree.  The BIA took their sweet time in recognizing the tribe.   Nick is in sixth grade and preparing for Spring baseball - he will be a Cub this year(which makes Q happy).  Allie is fun and energetic.

On Sunday we found a Catholic parish for Fr. Dermot to become a co-celebrant.  We went to our Episcopal service at 7:30 and then I went over to pick him up at the end of his 9 AM service.  One of the things that intrigues me about the Catholic liturgy is that priests can easily drop in.  The presiding priest for that service came from a retirement home and surprisingly had an Irish accent (from Kerry) - he seemed like a bright and charming person.

The Tuesday dinner had some discussion about all sorts of stuff - including some memories of when I first met Dermot,  The first year I was on Dermot’s first campus I was asked as a part of the Economics faculty to develop an exam for beginning students.  All of us had the chance to throw out questions for a common exam.  And after about an hour we came up with an exam which represented the issues raised by the course.  Although I did not teach undergraduates I was invited to participate,  What happened next was interesting.  The exams were numbered and then distributed on exam day.  When they were graded, the professors received a portion to grade without knowing who they were grading. - the exam was a substantial part of the grade.  No American University would have that kind of rigor.

Today was my sixth infusion.  I will schedule a pet scan to check on whether the treatments have eradicated the lymphoma if not I will do two more infusions.  I will also do a recheck with my Stanford team after the next pet scan.  So until we get the results I will be stuck in 6/8 time - fortunately I like Irish music and jigs and reels especially.





Saturday, January 4, 2020

Routines

Routines help organize our lives.  For the last couple of decades before I retired three routines defined my life - Airline Schedules, the School Year, the Legislative Calendar.   Routines can be helpful to organize if they do not prevent you from spontaneity.  

Airlines were simple - once you understood their rhythm.  You must first realize that if you don't have a private jet - that their schedules determine yours and that things you cannot control will happen.

In spite of my absolute commitment to technology I learned early on that much of what I did would be less successful if done via email, phone or FaceTime.  So I soon developed a set of routines, when the disruptions occured.  That required two props - a backpack with a laptop, a music source, and some snacks and what I called my ten day bag - which was remarkably compact and I could pack for a 10 day trip (that happened after I discovered that every city has laundries!).  The laptops kept getting lighter but then I added iPads (great for watching movies and reading books). During my career I amassed 2 million miles with one airline (United) and elite status with a couple of others.

The Legislative cycle and the school year were similar and very predictable.   Both had periods of intensity and downtime.  That was especially true when I was teaching because the courses I taught were in a format where you taught for 8 hours a day, four days in a row, twice, to make up a graduate level course.  There were subroutines too - I served on a series of boards and reported to one - they had their own schedules.   All of that was determined by someone else's choices - even though I had elected to be a part of those routines.

The last six months my routines have been very different - mostly consumed by appointments with medical personnel - more than 60 visits with a variety of practitioners.  Early in this process, when I was feeling lousy, that was about all I could do.   

As my treatments have had a positive effect, I've begun to think about new routines which will accentuate my natural goal orientation but not lock me into drudgery. .  There are some continuations - Indy gets walked at least twice a day - that is a good time to think but also to listen to a wide variety of books. I'm just walking a bit faster than in August.   My daughter got me started on a project called Story Worth - which is a set of prompts issued weekly that will be compiled into a book.  The first two questions were what was your mother/father like when you were a child.   The compilation could lead to serious work on the book I mentioned in the last post.

A compromised immune system has barred me from the gym - but I have set up one in our house.  With the treadmill (an apt analogy if there ever were one) I feel honor bound to use the damn thing (and I have).   Before you declare brain death for the writer - understand that the time I spend on the machine is a chance to scour Prime and Netflix for old movies.   

But I have begun to rebel against social media.   Facebook is often, if not always, an echo chamber.  I have rarely used Twitter and the other feeds.  And I am beginning to think about how we will get to SMA when I am cleared from these cycles.  I am down to one board, Samuel Merritt, and will step down as Chair in June.   But if you are a goal oriented person, as I am, you need projects which evolve into routines.

One of the most enjoyable routines I have engaged in in the last couple of years has been in working on efforts to change higher education.   In June, I completed a role as a sell side advisor for an institution that had plenty of resources but needed to ally with another institution to survive.  That was the sixth of those type of transactions I've worked on - and it was fun.  I got a very nice note from the former President of the institution I worked with complementing me for the job I did.  So I will look for a couple more of those unique opportunities.

Where I won't go is trying to improve our political fabric.  I am truly depressed about how divided our country is about key issues - no understanding of E. Pluribus Unum and very little willingness to think about how to restore that essential part of the American system.  But I simply do not have any good ideas about how to help bridge the gap.  I think part of the problem comes from how much more government is a part of our lives but I also think the problem is deeper.   Thomas Sowell wrote a prescient book in the 1980s called A Conflict of Visions (https://www.amazon.com/Conflict-Visions-Ideological-Political-Struggles/dp/0465002056/ref=sr_1_1?crid=V5K18OO6B9AJ&keywords=conflict+of+visions&qid=1578181532&sprefix=Conflict+of+Visi%2Caps%2C201&sr=8-1) which argued that liberals and conservatives have very different understandings of key terms like equality and justice.  While we faced perils when there were only a few channels for the MSM, that problem has been exacerbated with the multiplicity of options today. I tend to ignore ALL Cable Channel news but as a conservative a lot of people think my sources are only from Fox News.  One effort where I can have an effect is to try to communicate my thoughts and opinions in a respectful way - recognizing that there could be different approaches.

The bottom line is that with the discontinuity caused by my illness, it has allowed me to think differently about the role of routines in my life. 

Sunday, December 22, 2019

Steps with Determination(s)
There were several developments this week.   First, I got a haircut.  Not a big deal?  Since my last one was in the summer I was looking a bit like a cross between the Great Quillo and Howard Hughes in Vegas without the nails (as a former wrestler I have always kept my nails short). (My God this blog spends an inordinate portion of its writing on personal grooming)  After my last haircut, my former barber -  who owned a one chair shop near our old house in Curtis Park, decided to retire.  He had cut my hair for almost 40 years, precipitously decided to retire at 82. (i think the events were coincidental not causative).  My new barber, who is in the Fair Oaks village, thought that after the new haircut I looked somewhat like Steve McQueen.  If so I want the Mustang from Bullit. The first picture is of one of my favorite chickens in Fair Oaks - which is a rough representation of what my own hair looked like before the haircut. 

On Thursday I had one more acupuncture treatment, My regular acupuncturist was gone and thus his associate was there.  She chose to put the sounds of waves crashing against the shore,   Part of the rhythm of acupuncture is to offer contemplative music,  I find that distracting because it seems to be an endless loop of almost distinct toons.  I keep wishing the music would finish a phrase but it never does.  I found the wave sounds dandy.

Then there was the visit with my Oncologist.   As is the practice I have a visit with him to go over the numbers coming from the most recent blood test and to prep for my next infusion.  I am a numbers guy so I always have a list of questions about the numbers.   He thought things things like my “Mean corpuscular hemoglobin concentration determination” and my “Hematocrit determination” are mostly hunky dory.  (Not a medical term).  Believe it or not, in the spreadsheet I keep to record the numbers, I have put short definitions to remind me of the various meanings of “determinations”.   I feel a bit like an Economist at the WH Economics Council - I think there are 20+ stats to track - but it comes down to four key indicators;  hemocrit determination (volume percentage of red blood cells), lymphocyte percentage (white blood cells), platelet count (blood components that determine clotting) and white blood cell count (which are part of your immune system but which Chemo destroys).

We also discussed next steps. As the cards are today, here is what we know.  I do the fifth infusion on Boxing Day, the day after Christmas.  Then sometime in January I will go back to Stanford for a consultation with the Stanford team - just to see if they concur.  My doctor here thinks two sets of eyes are better than one.   That is refreshing.  Many doctors would not think this step necessary.

At this point there are probably two options - assuming that everything is positive after my sixth infusion and a third pet scan I will be cleared as being in remission.   If there are still signs of the little buggers then I will do two more infusions, delaying my return to Mexico for another six weeks.  Obviously, I would prefer the first option.  Preferences count for little here; I am fully prepared for the  second shot should it be necessary.

This is our first Christmas in the house that we moved into several years ago.  I had forgotten how grey Sacramento is at this time of year.  Friends in SMA say this December has been cold and grey there too.  Last December, it was cold.  You learn that in houses that are primarily stone and which have no central air or heat, it can be cold.   Our house, until the most recent remodel, which was completed last week - had only unvented gas fireplaces - which require you to keep a window open when using - and thus are not really useful for heating a house.   One of the things we did in the remodel was to add a vented gas heater in our bedroom.   But the first two weeks of December in Fair Oaks has been wet and cold.  I know friends in the midwest think cold is 40 or 50 degrees less than I do - but as a native Californian, 35 degrees is cold.

As with all things, there are good signs too.  This morning, as always, Indy and I were out and beat the coming rain. Sacramento is expecting wind and rain and snow at the higher up elevations. Then it started to rain seriously on the way to our 7:30 service.   You might ask why we go that early; for one reason I hate crowds.  For another, Quinlan then goes to her water aerobics class. As we were walking into church (by this time Indy was back in the house and dry) the rain cleared momentarily to be able to see a double rainbow.

I am a big rainbow fan.

One final comment - this morning at St. Paul's San Miguel the knitting ministry, of which Quinlan is a member, offered some prayer shawls for blessing before distribution.   For the last several years Quinlan has been a yarn mule - bringing a special kind of yarn to SMA for her various knitting projects (she is a member of two knitting groups).  One of our friends proposed to include Quinlan in the blessing and thus connected via FaceTime - isn't technology wonderful?