The Perfect Day

Last Friday was the perfect day. How, you may ask, is it possible to marry off your daughter in a city 600 miles from both the groom and brides home, cater your own reception and have a wonderful time where everyone is relaxed and enjoying themselves? It is a wedding miracle. You start with the bride's desire for simple elegance. To that add two easy-going mothers-in-law. And finally, the focus was primarily on the temple marriage; the party that followed merely remained as a time to laugh and meet new relatives.
Rebecca and Jason beamed with excitement as they exited the temple to greet cheering family and friends waiting in the gale force winds blowing through temple square in Salt Lake City. Photos were attempted with hair blowing in all directions (for those with hair). Soon, Barbie and I were off to Draper, UT to a greenhouse/nursery where we would have the reception with tropical rains pelting the glass roof. It was a simple spread; cheese and crackers, mixed berries, saute'd meats with dipping sauces, sparkling lemonades and, of course, a huge cake of many colors (on the inside). Everyone pitched in to help.
Caitlin played the piano and sang a song that she wrote for Jason and Rebecca, followed by Rebecca performing a song she wrote specifically for Jason on their special day. Tears and lemonade flowed freely.
Barbie and I bid farewell to the newly wedded and as we drove back to the home of Barbie's parents, she observed with a very relaxed sigh, "That was the perfect day."

Kevin

A day with Caitlin

When I was sixteen I purchased the album, "James Taylor's Greatest Hits. It was the first record I had ever bought. He was the one artist with whom I could sing along because he is a true baritone. I have always wanted to see him in concert. When I saw that he and Carole King were performing together, I had to go. I bought the tickets on the spot. What I did not realize was the fact that Barbie would have her chemistry final on the same day. In addition, I later found out that it would also be the day of my four-month heart biopsy. I decided to take Caitlin as my date.
Tuesday morning at 4:00 A.M. Caitlin and I drove to Santa Clara to arrive in time for my 7:30 heart biopsy, 9:00 AM clinic visit and 10:00 AM chest x-ray. The heart transplant support group was from 12:00 - 1:30 PM and then I had a psycho-cognitive evaluation by Dr Epstein as part of a study he is doing on whether transplant patients remember to take their medications.
It was then time to go to the beach. Thirty minutes later we were in Santa Cruz on the Boardwalk. We loaded up on cotton candy and rode the Giant Dipper, an 85 year old wooden roller coaster. It certainly creaked like an 85 year old cripple. We dined at the Cheesecake Factory and then went to the concert. I was one of the youngest people in the audience. We watched as people rolled in in with wheelchairs and with canes and walkers. We knew we would be 'rockin out' (assuming you had brought your own rocking chair) No warm-up band; they started just after 8:00 PM. Given the combined library of these two prolific icons, we were carried away with one hit after another. James Taylor was fantastic, but Carole King stole the show. Her powerful voice filled the stadium with "I Feel the Earth Move Under my Feet". But the place went crazy, especially the women, with her anthem, "You Make Me Feel Like a Natural Woman". I was transported back to my high school and college days. Carole King looked like she was in her fifties, but then she mentioned that she had her first hit in 1956. The years have been good to her.
Soon we were back on the road for the 2 1/2 hour drive home, Caitlin slept (so did I), but we made it safely home.
The heart biopsy result was NER (No Evidence of Rejection!) That is always good news.
Caitlin and I had a wonderful day together making father/daughter memories. She really is a sweetheart to spend so much time with her over-nostalgic dad.

Kevin

Weeds

Yesterday I sat in the middle of the garden pulling weeds. (I cannot bend over or squat anymore.) I am not supposed to work in the dirt because I might inhale opportunistic infection agents such as aspergillus, So I held my breath for thirty minutes. (I have had some practice in breath-holding in the past few weeks). The intruders had overtaken the garden in a dense mat of intertwined interlopers. However, I soon found that one weed in particular was the source of the majority of the mass. It had spread its metastatic tentacles over a 1 square meter of space, occasionally shooting feeders down into the soil. I slowly separated this mess from the other weeds and drip system only to find it attached to the earth through one tiny stalk. I carefully pulled up on the stalk and, of course, it snapped leaving an equally elaborate root system below. We delude ourselves as we then look at the bare garden with pride; for the lurking roots our just waiting to return. I decided to rename my diease, amyloidosis, 'weeds'.
Somehow it feels the same. The tentacles of aberrant proteins choke off the good organs to prevent their normal function. I can 'Round Up' these invading plasma cells with drugs like Revlimid or Velcade. But there is always the risk of simultaneously killing off the good fruits of normal tissues. At one point I thought, "Only an atomic blast would annihilate this unyielding root system, similarly, a complete stem cell transplant might accomplish the same goal. Alas, these buggers are sneaky as it only takes one lone survivor to perpetuate the population. So we survive by occasionally trimming back the weeds to at least temporarily provide sufficient light, water and nutrients to the life giving plants that nourish us as we nourish them.
I took two months off from chemotherapy and felt wonderful, but the weeds grew and my light chains went over 160. After one course of Revlimid/Decadron/Cytoxan they have decreased to 130, but with the price of fatigue and malaise. But, the garden continues to grow and, with faith, this will be a very productive this year.

Kevin

Graduation

Rebecca, Jeremy and Alexandria

We spent a wonderful four days in Utah to witness the graduation of our son, Jeremy, our daughter-in-law, Alexandria, and our daughter, Rebecca graduate from Brigham Young University. The commencement for all of the graduates was on Thursday afternoon, while the individual convocations were on Friday morning at 8:00 AM in different locations. Barbie and I split up to attend both and kept in contact through texting as the separate ceremonies proceeded. Soon it was evident that Rebecca's smaller class in Advertising and Communication was already walking up to receive their diplomas so I raced from the Marriott Center to the Fine Arts Building and made it with two minutes to spare to see Rebecca. I yelled loud so that she would know that I was there. I ran back (I actually never run) to the Marriott Center with Barbie, Caitlin and Lydia (my mother-in-law) arriving soon after so that we could all see Alexandria graduate in Food Science and Jeremy graduate in Physiology and Developmental Biology. Thanks to modern technology we could be in two places simultaneously. Additionally, my nephews Doug Hulbert and John-David Anderson graduated in Electrical Engineering and Law respectively.
Saturday morning we cheered as Jeremy and Alexandria finished a half marathon at Thanksgiving Point in Lehi, Utah. We are so proud of our children and the responsible choices they continue to make. Now on to the next chapter, Rebecca and Jason's wedding on May 21st.
The last three weeks have been tough physically as I am back on chemotherapy which leaves me tired and unmotivated. I still function, however, mostly driven by duty. I know when I am feeling better because I want to cook and to write (in that order). Work is very busy and I cannot keep up in a three-day work week, but I stay afloat. Speaking of drowning, I have to wear a splint on my finger for 6 weeks due to the ligament tear I sustained trying to save myself. I have a 'mallet finger'. It makes surgery challenging, but it is better than the alternative. I still have flashbacks to the underwater terror, although they are less common now. Next time I go snorkeling, I will be better prepared.

Kevin

Blossom

Have you ever regarded a blossom for more than a moment?

Maybe fifteen moments or even a minute

So close that the fragrance fills your senses, 

but with the softness remaining in constant focus.

Can such singular regard preserve the comprehension of the whole?

The leaves, translucent green as new tender shoots of spring

Capturing the sun, breathing the air, drinking the morning dew

All to nurture the flower that ensures their existence.

The twig, the branch, the trunk

Buried roots in soft earth

Land, air, wind, sky

Clouds roll by to promise the possibility of essential rain

All combine in time to create.

Small delicate pink with lines of red

In its fragility lay the seeds of strength

Yesterday a mere bud; unopened

Tomorrow a phantom petal on the breeze

Today the majesty of beauty simple

Can a human by thought or deed exceed the magic of nature?

The Gift of God given; to behold and wait on this coupled variety

To finally see the greater whole.


Kevin

A beautiful kidney stone*

Maybe there is something inside me that enjoys searching in salt water for interesting things. Last Monday this resulted in me being attacked by vicious rocks. Today it was my turn to strike back. Using my trusty ultrasonic jack hammer it was my pleasure to pulverize a saline submerged stone. This stone was also causing pain; to one of my patients.

The procedure is called a percutaneous nephrolithotomy. Essentially, this is accomplished by placing a needle into the kidney and passing a wire through the needle into the kidney and down the ureter into the bladder. Then a balloon dilates a tract big enough to insert my nephroscope directly into the kidney to break up and remove the stones. We irrigate with saline to be able to see what we are doing.

Today, the patient had a very odd looking stone; Its vanilla, verrugated outer shell was atypical for a human stone. But then as we broke off the end, we could see that the inside was hollow like a geode with beautiful crystals visible throughout. I just had to get a picture of this unusual treasure while snorkeling through inner-space. I include it for your viewing pleasure. I know that some people will say 'Yuck' based on the awareness of its origin; I however, paused for a moment to reflect on its varied uniqueness before crushing it out of existence.

I know the patient will thank me later.

Kevin

*Posted with patient permission

Over the river and through the jungle

Cuts

Of all of the places that I have visited in Mexico, I believe that Puerto Vallarta is now my favorite. As much as I like the climate in the Gulf of Mexico, this Pacific coast town is quite pleasant. It is a modern city that has not forgotten its past. On the journey up the canyon of the Rio Cual we passed many small humble huts that blended, but did not impose, on the surrounding jungle environment. At one bend in the river a dozen tents of camping families dotted the beach with laughing children nearby played in the shallow water. Interestingly, laughter is the same regardless of language, while crying is not.
Soon the truck carrying us intrepid adventurers arrived at a location high above the river below and, after a brief safety instruction; we donned our harnesses and became one with gravity. To use the zip-line, the guide attaches your pulley to the cable and then connects one carabineer to the pulley and a second safety around the cable. Then you glide over the jungle. We must have been at least 150 meters above the river below. On the other side a guide would ‘catch’ you, unhook your lines and then we would hike to the next zip-line. This was hard for me as I would get out of breath hiking up the steep mountainsides, Caitlin would always stay back with me as I slowly trudged forward. But soon my energy would return and I would be flying back over the valley. If you looked down you would see the river below. To the left was the Pacific Ocean miles down the canyon. On the longest and fastest zip-line, Barbie went upside down and backwards. Finally, after riding 13 zip-lines, we arrived at the river basin and a team of mules carried us back to the base camp where we relaxed under a thatched roof patio sipping Squirt and eating Nachos and Guacamole. Caitlin, always concerned over my well being exclaimed, “Dad. You’re not supposed to drink grapefruit juice!” to which I responded “We just glided over the jungle 13 times, I’ll take the added risk.”
Speaking of risk; I am slowly healing from the injuries I sustained on Monday. I only feel pain when I walk, sit up, move, touch anything or lay down. So far I don’t have a fever or cellulitis. The daily application of Neosporin and antibiotics seem to be working. Given that I am immune-suppressed, I get concerned with just one cut, let alone one hundred. I can walk, but slowly and with a limp as I have two deep lacerations on the sole of my right foot. (Not deep enough for stitches.) We still have two more days on the boat and, other than dancing or getting a foot massage, I can participate in most other activities, namely eating. I will recover from this, but the experience has shaken me up emotionally. I almost died, not secondary to some disease out of my control, but rather due to my own overconfidence, ignorance and poor judgment. I should know better. Yes, I have learned a lesson. We managed the zip-lines safely because we were prepared and followed our guides. I know now that I must always have a safety line, a buffer as it were, whenever I venture again into the unknown.
Kevin

Battered, Bloodied but still Breathing; Barely

Cliffs of insanity

At age twelve my mother sent me out onto the roof of our house to fix it. It was a flat roof over the family room that had a leak in the corner. It was my job to reapply tar to that area. At some point I must have made some terrible mistake because I remember my mom yelling out of the window commenting on my error. She then added, “How can someone who is supposed to be so smart do such a dumb thing?” Immediately, in my mind, I retorted, ‘Who said I was supposed to be so smart?’. Two years earlier the school psychologist had administered an I.Q. test; the results of which were denied to my immature eyes, but rather given to my parents. I don’t think that was fair.
Today I did a really dumb thing. Among the activities that I truly love, there is snorkeling. Floating above such a variety of sea creatures is so serene. It has been years since I have had such an opportunity. We anchored in Cabo San Lucas this morning and I was first in line to get off the boat. Once on shore we haggled a good price for a water taxi to ferry us to Lover’s Beach. This secluded beach resides near the tip of Cabo’s famous rock formations. Within minutes I was in the water while Barbie, Rebecca and Caitlin remained on shore to read and sunbathe. I had a mask and goggles, but no flippers as they were too big to fit in my suitcase. Soon I was gliding through a cornucopia of beautiful tropical fish. But then disaster hit; my curiosity replaced my better sense. From the shore it seemed that the rock formation where I was swimming might contain a passage back on the opposite side between the rocks and the cliffs of insanity. (See figure above and note white water to the right of the photo.) I decided to venture on and explore this diabolical chasm. As I swam into the narrow space I saw hundreds of fish, but soon I noticed that the force of the waves hitting the rocks ahead were pushing the fish back underneath me. I craned my neck up out of the water to see if I could see a passage through them back to shore. I could not. At the moment I was debating whether to turn back, the ocean took away all of my choices. A wave hit me, from behind or in front, I could not tell. I saw bubbles and blue and franticly swam to what I thought was up. It was no use. I could not fight the power of the waves. I was gasping now, but my submerged snorkel prevented me from inhaling water. For a brief moment I saw sun, but only a second. I quickly took a half a breath, but then was under again. I fought to regain the surface but failed. It became clear that I was not strong enough to overpower the churning whirlpool. As I struggled in vain, I was abruptly thrown against the rocks on the cliff side. I saw a small rock jutting from the face and grabbed it only to have it break off in my hand has another wave pulled me again down into the abyss. I thought, ‘How stupid I am, Barbie can’t even see me, no one can. This is it, I am out of breath, I can’t last much longer.’ It is amazing how easy it is to drown. This is the second time in my life that I nearly drown. The first time I was seven and fell into the Eel River. Fate, luck, divine providence intervened then as it did now. Soon a wave threw me to the rock side and for a split second I saw a substantial vertical outcropping shaped like a handle and completely covered with razor sharp barnacles. I held on for dear life and the wave receded exposing a rock shelf near my feet. I swung my leg up and pulled myself out with what strength remained. I stood there for a long while and breathed. My will was again my own.
To get back to shore I would have to climb over the rock. I could not return the way I came. Once the hyperventilation slowed I began the slow ascent. Facing the rock I noticed hundreds of barnacles per square foot. ’Oh well,’ I thought, ‘Our pathways can’t always be without pain. And besides, pain meant that I was still alive.’ I got to the top of the rock and saw a place free of malevolent crustaceans and sat down. I looked at the rock next to me and saw bright red blood dripping at an uncomfortably fast rate. I looked at my legs and they were also covered in wet blood. In that moment I wondered what was my platelet count. I have been off chemo for a while so I assumed that they were adequate to the task. “Go Platelets Go…..Goooo Platelets!!” I looked to the shore for Barbie. I thought I saw them where I had left them reading their books. I sat for a while considering my next move. Below me a dozen blue shelled crabs scurried sideways over the rocks. The rock face was more gradual on this side as the shelf became submerged. This was my way out. As I looked up a man on the shore was calling to me. Right behind him was a very concerned Barbie. I waved to indicate that I was alright. I knew that they couldn’t come get me, though. I slowly descended like a crab with my hands behind me and was finally back in the water with mask and snorkel in place. I swam and soon saw the man’s feet indicating that I could stand. Barbie then came and walked me back to our towels where we waited for the water taxi. Everyone on the beach was shocked to see this bloody mess of a man limping and dripping as he passed them on the sand; So much for Lover’s Beach. We assessed my wounds. I had cuts all over my body, mostly on my hands, feet and lower legs, but nothing that needed stitches.
Barbie wanted me to see the ship’s medic, but you know me, I am a surgeon. I have taken care of these types of wounds many times. Certainly I could treat myself. After a shower, Barbie lathered me with Neosporin and applied a multitude of Band-aids. I gave myself a broad spectrum antibiotic and went to lunch.
Sometime the rocks in your head and the rocks against your head meet and the result is not pretty.
I will survive to live another day so that tomorrow I can strap on a harness, hook onto a steel cable and glide a hundred feet over the jungle. At least that will be safer.
Kevin