Day -3

“Draw a square with three straight lines,” the janitor said to me. I looked up from the paper at him and thought to myself, I’m not sure I have the energy to do this. “Don’t overthink it!” You’re talking to the wrong guy, buddy! “And no, you can’t use the side of the sheet of paper as an extra line.” My head felt packed with cotton wool. I wasn’t really enjoying the challenge. In reality, I could barely even under-think the problem. When he wrote answer, □ |||, all I felt was tired. Next puzzle. “Suppose you got a wolf, a sheep, and a lettuce on one the side of the river, and you need to transport them across to the other side. You can only take one at a time, boat’s not big enough for more. But you can’t leave the wolf alone with the sheep; the sheep will be eaten. And you can’t leave the sheep alone with the lettuce, or the lettuce be eaten. How do you get them across?” I couldn’t get any farther than taking the sheep across first. I was mad about that because, unlike the first puzzle, this one was no trick. I blamed the cotton wool in my head.

BF is a breast cancer survivor. During treatment she received chemotherapy once every three weeks for four or five months. She used to speak of “chemo brain,” a generalized lack of sharpness. I think it’s descending on me, and I think the janitor knows. Don’t let me make any bets with him!

Yesterday when MF came to visit, I presented both puzzles to him. He also gave up on the square and three lines one, and he was not happy about the right answer. But he cranked out the answer the river crossing. It goes like this: First, take the sheep across. Next, go back with an empty boat; grab the wolf and deposit it on the other side. But before crossing back, grab the sheep; cross back with it; leave the sheep; but grab the lettuce. Go back across with the lettuce; leave it over there with the wolf. Finally, go to the original side with an empty boat; pick up the sheep; and bring him to the other side. MF may have a career in logistics, or maybe directing.

Yesterday evening and last night were thankfully considerably better than the night before. Even though I slept reasonably well, I noticed this morning that it takes me a long time to get going in the morning. I did finally get to my exercise routine, and take my shower, just before the nurse came in to put a bag fludarabin on Ginger Rogers and hook me up.

The question of what to do about my kidneys and chemotherapy was solved by compromise. You might recall that the doctor spoke of a trade-off between the possibility of the fourth day of chemo damaging my weakened kidneys, rendering me dialysis dependent, and receiving only three days of chemo, as typically people over 60 do, which would make the transplant itself a bit more risky. She recommended splitting the difference. So, on this day, the fourth day of chemotherapy, I received only the fludarabin and not the bulsavin. She has done it this way before with success and she seemed confident. Who am I to know better? As patients we put ourselves in the trust of doctors. We make ourselves vulnerable to their judgments. It’s not that we have no role to play at all. For how we want to live is at stake. But we can’t pretend to have better grasp of the empirics than the doctors.

I’m fuzzy in the head, dizzy when I stand up, and tired most of the time. I’m hardly a model decision-maker right now. Two things stand out about that short discussion and decision. First, insofar as she is recommending a slight reduction of chemo on behalf of my kidneys, she must be confident that the reduction does not change the likelihood of success all that much. Why do something on behalf of my kidneys, if I’ll be dead? Second, when I first spoke to her early last summer, she seemed eager to point out the risks of a transplant and unwilling to recommend any decision at all. She adopted the position of informing, not advising. Just now, her stance was firm. She must feel strongly about it.

Being a patient is not only about being patient. There’s a boat load of trust involved too.

Day -2

Day -4