Wednesday, May 30, 2007

If Toby had so much mucous, then why was it a better day?

Last week, when toby was still in the hospital, i came home to have dinner and spend the night with yoni. toby had been admitted for the second time in two weeks, he was neutropenic and his intestinal tract was lined with painful sores all the way from mouth to bottom.

i rarely have any one-on-one time with yoni and we certainly don't have a chance to catch up on standard teen topics (he's almost 15). instead, yoni asks me how toby is doing and i report back something like this: "he's better, honey. he had more energy today and could actually watch tv. he had 8 spoons of broth. he didn't cry that much. and he only threw up once when we gave him medicine. what did he throw up? oh, the broth and about a quart of mucous."

yoni was quiet for a moment and then made this brilliant statement: "If Toby had so much mucous, then why was it a better day?"

It took my breath away. I laughed and laughed at the truth of his words. From the mouths of babes indeed. perhaps unwittingly, yoni had arrived at something very deep: an attempt to understand the enormous shift in perspective that cancer has wrought upon our lives.

six weeks ago a scrape or tumble was cause for alarm. now i watch as toby endures daily pain that most of us cannot even begin to imagine.

cancer has robbed my child of his softness, his innocence, his curls, his ease, his strength, his body, his endurance. It has also revealed some remarkable things. I have a little boy who says “please” and “thank you” and “excuse me” as poisons drip into his bloodstream. I have a little boy who has rediscovered the love of his older brother, playing catch together for 20 minutes after being released from the hospital. I have a little boy who sits on the stoop with his cousins and tells them that he is about to change their bandages and give them shots that will hurt.

cancer makes the world outside the hospital seem unreal and soft at the edges. I stumble into the light after days and days on the 9th floor and I can’t understand what I see. Every person, every tree and house and street and interaction seems so vulnerable and beautiful that I want to cry. Did I live like this too, before april 17th? Did I notice that even Brooklyn looks like a thomas kinkade giclee reproduction?

cancer makes words like “brave” and “courage” sound ridiculous. sometimes, during a particularly painful procedure, the nurses say to toby, "you're being so brave!" or a friend will tell us how courageous we are. honestly i don't know what those words mean. Maybe they are placeholders for feelings that are much, much bigger and unwieldy. They’re safe words, but they aren’t really true. Here are the words that speak to me: fear, numbness, why, desperation, intense love, sadness, more fear, exhaustion, hope.

Our perspective has shifted and I find hope in strange places.

Toby threw up a quart of mucous, but he giggled when we tickled him under his arms.

The pale, skinny, hairless children at the hospital don’t look half-dead to me anymore. I can identify them, I can match them to their parents, seeing them day after day is enormously reassuring to me. The children look half-alive now.

I sometimes find it hard to look at healthy children. They are so beautiful. I cannot believe how much they climb and laugh and run and whirl around.

and this: The children at beansprouts are studying insects: the ladybug sheds her skin over and over again, each time revealing new skin underneath. One day she feels very tired. She stops eating and curls up. And then she waits. When her new skin grows hard, it splits and she climbs out of it one last time. She is very, very pale. She waits. Slowly, slowly, slowly her color grows stronger. Her black dots appear. She is a ladybug.

We love you all. Pray for Toby.

mooki and stephen

Monday, May 28, 2007

Toby Weekend Update

I've just returned (along with my wife Gila, & our 2 girls, Isabel & Ayelet) from NYC where we spent the weekend with Toby, Yoni, Mooki, & Stephen.

I haven't seen Toby in several weeks & this was the first time Toby's cousins have had an opportunity to visit since he was diagnosed (Isabel & Ayelet traveled to NYC a few weeks ago, but Toby was admitted to Sloan the day of their arrival so they couldn't visit).

Toby greeted us Friday afternoon bald & quite a bit skinnier, but still as sharp & inquisitive as ever. After a short "warm-up" phase, Toby, Isabel, & Ayelet were like the three amigos. Toby, sat on the couch & played DJ, adeptly manipulating his trusty boom box between various favorites, all the while grooving to the tunes. Stephen's "shake it, don't break it" was all the motivation he needed. Isabel, never one to shy away from an opportunity to dance, somehow managed to adapt her ballet moves to keep in step with Toby's eccletic tunes. Not to be left out, Ayelet (inbetween stealing bites from Toby's perfectly color coordinated, diverse, & healthy plate painstakingly prepared by Mooki) rolled between her cousins on Toby's Good Humor truck.

The cousins then made for the closets where Toby introduced the girls to one of his favorite games "elevator." They traveled between the various floors of Macy's with Toby acting as elevator operator, food deliveryman, & chef. By the early evening Toby was running(!) from room to room & while not nearly as chatty as Isabel, he held up his own. By dinner reality had snuck back in; Toby began to limp & while we cleared our plates & then some, Toby nibbled only at his food. While we were enjoying each others company, Sonya & Itamar were packing up part of the 13th St. Apt (& they returned today for more).

Saturday we headed to the Clinton St. park where the cousins played "train." They pushed their carriages around the circle at least a dozen times. We then tested each other's accumen imitating animal-calls based on Ayelet's choice of various creatures. Yoni & I played whiffle ball (he's very good) & then we all walked to Nino's Pizzeria for lunch. While Toby took a well needed 3 hour nap, Yoni & I went to Prospect Park where we played more whiffle ball & frisbee (he's pretty good at that too).

After a late dinner, Toby, Mooki, & Stephen went out for Italian Ices.

Sunday morning, Mooki took Yoni to Prospect Park where she filmed him launching rockets. Toby & the girls played some more & I got a chance to read Toby & Ayelet one of my favorite books (Bee Bop Express) about a train hauling jazz musicians from NYC to New Orleans.

As expected Toby left his mark on us all. Ayelet (2 years-old) has a new mantra, "Toby & Yoni my cousins, I love them." I feel very fortunate that we were able to enjoy a semi-normal weekend with Toby, which will probably be the last one for a while. Tuesday, Toby has reevaluation scans to assess how much his tumor has responded to the chemo. Later Tuesday he starts his 3rd cycle of chemo (this time with 2 different medications he has yet to receive). The idea being to keep the neuroblastoma from developing resistance to any one group of medications. One of the meds Toby will get (cisplatin) is especially nasty, in the immediate phase it can cause pretty significant nausea & vomiting & later it has the potential for causing hearing loss.

Following the 3rd cycle, Toby will have a repeat bone marrow evaluation (the results of Friday's marrows are still pending) & the surgery to remove whatever tumor(s) is/are left.

Please donate blood & platelets if you can.

I'll keep you posted as things develop.

Yoram

Friday, May 25, 2007

bone marrows


i still haven't posted that update, but wanted you all to know that tomorrow morning toby is going in for bone marrow aspiration and biopsy, to see if his marrows have responded to the 2 mega cycles of chemo so far. on tuesday we will start cycle 3 of chemo.

when toby had his first marrows done on april 21, i remember the doctor coming out of the operating room with gallon ziplock bags filled with vials and vials of toby's soft spongy tissue. he told me that he could see tumor in the marrows with his bare eyes.

i can't even think about tomorrow. i am so scared. and i pray that toby's marrows are cleaner. our wonderful little boy who can tell you about every train in the subway system, who is beginning to add numbers, who loves tomato soup, who delights in birdsong, our little toby deserves to have clean marrows.

mooki

Wednesday, May 23, 2007

toby is home!

just a quick note to let you all know that toby's counts came up during the night and we are now home on kane street.
i'll post an update later tonight. for now we are going to enjoy this beautiful afternoon back in brooklyn.

love.

Tuesday, May 22, 2007

Some more Toby information


Toby was admitted today because of a known, but particularly nasty side effect of his chemo. In addition to wiping out his bone marrow, the chemo's not all that smart. By this I mean that in addition to targeting neuroblastoma cells, the chemo affects normal cells, especially cells that have a quick turnover rate. The cells that line the intestinal tract, all the way from the mouth to the bottom are especially susceptible to chemo. The result is that Toby's mouth, esophagus, stomach, & bottom are raw, tender, & ridden with sores. This obviously makes things like talking & swallowing very painful let alone eating & drinking (imagine trying to chew something salty or crispy with open sores).

Toby's weight is down & he's dehydrated, so his docs decided it was time he start TPN (nutrition that he'll receive through his iv). The hope is that as Toby's marrow recovers & his sores resolve, he'll be able to resume eating on his own.

I'll keep you posted.

Yoram

Monday, May 21, 2007

Toby is back in the hospital.

He arrived to the clinic today and was immediately given i.v. fluids, as well as blood and platelet transfusions.

This weekend Toby was couch-bound; the energetic, playful, and active Toby of last week succumbed to the reality of chemotherapy. Toby's inbetween the second and third cycles of chemotherapy and his bone marrow is pretty wiped out. This means that he has very few white blood cells to fight off infections, hemoglobin to carry oxygen to the body (and a prime source of energy), and platelets which clot the blood and prevent bleeding.

Toby's skin is covered in crops of purple and black bruises (as a result of too few platelets) and rather than exert himself like a normal four year-old, he preferred to remain motionless on the couch (not enough hemoglobin).

Toby needs for as many of you as possible to donate blood and platelets, not only before his surgery (scheduled sometime after the third round of chemo), but now too. If you're able to please try to get over to Sloan and donate.

Thanks,

Yoram

Comment on 5/17 post

Dear Mooki,

Your poignant account (5/17) of a 6 week struggle to find out what was wrong with Toby mirrors my 4 month trial to get a diagnosis- ovarian cancer.

You are so generous in sharing your raw emotions, and humanity. You invite us into the heart of your family- I love the scene of Toby running back and forth, while Yoni is belting out, "If I were a rich man." You express yourself so well- it's no wonder Toby is so articulate!

The reason I'm writing this on the public blog is so everyone reading it will learn from you how we need to advocate for our own health. Dr, Jerome Groopman, author of "How Doctors Think" (March '07), has been interviewed on national TV. He feels that doctors often think inside the box, and make up their minds about the diagnosis in the first few minutes of the visit, especially now with time-limited appointments. He says, "Doctors frame patients all the time using shorthand, and fail to question their (own) assumptions." So, "Doctors desperately need patients and their families to help them think...How a doctor thinks can first be discerned by how he speaks and how he listens; how he asks questions and how he responds....Emotion can blur a doctor's ability to listen and think."

And if we don't get the answers we need by polite conversation, we may need to "scream', as you did, or at least, become firmly and persistently aggressive, as I did. Shalom!

Posted for Aunt Blanche