Dear Folks, It’s a sunny, beautiful Saturday afternoon following a night of new SNOW!  The farm is white-blanketed and peaceful, except for the feisty gangs of pine siskins and evening grosbeaks at the feeders.  Karel and I spent the morning at the Herculean task of cleaning up the basement — a job that is often begun and never finished at Foundation Farm.  This afternoon Don, Sylvia, Heather, Karel, and Karel’s new girl friend Stephanie are out bowling (something I’ve never known any of them to do before).  I’ve got a pot of chili simmering on the woodstove and dough for English muffins rising.  The radio is playing Rigoletto live from the Met.

On the windowsills and on a big plant cart in my bedroom are SPROUTING SEEDS!  Peppers, onions, celery, celeriac and fennel, primula, petunias, geraniums and pansies — the early starters are warming themselves in the strengthening sun.  Every weekend there will be more to plant until we’re crowded out, and then it’s time to put up our collapsible greenhouse and move things outside.

Two days ago Sylvia’s sister (former Farm resident) Binky had a BABY BOY!  Three weeks early, over six pounds, Mom and baby doing fine.

Heather has learned how to do PUZZLES!  (In fact, since she’s learned, it’s hard to get her to do anything else.)

It has been a LOVELY MONTH!  It’s about time you heard news like that from me, isn’t it?  So much has happened in directions of strengthening and uplifting and healing.

Remember the doctor from whose care I escaped?  I was tossing and turning one night, knowing that I had made the right decision but hadn’t ended it right — I had disappeared from his practice and left it to official channels to tell him what happened.  So I got up and wrote him a long letter, telling him why I asked for another doctor and sharing my feelings about him — feelings that ranged from outright terror of his temper to true admiration for his brilliance, from thankfulness for the times when he was gentle and honest to anger at the times when he hurt and humiliated me.  I ended with the emotions that I was feeling then as I wrote — sadness that I had to leave his care, compassion for his pain, whatever its source, and concern that his pain could get in the way of healing his patients.

That was hard to do.  I never wrote a letter like that before, not to someone I was mad at.  But as I wrote, of course, I got less mad.  I saw him more whole, and I began to care deeply not only about my healing, but about his.  He is too talented and sensitive and dedicated a man to have depression and temper stand between him and his patients.

I gave the letter to his nurse to hand to him at the end of the day.  The next day I got an answer.  It was the most gracious, supportive letter you can imagine.  I was in tears of happiness and relief by the time I finished it.  I told my new doctor that there was no hostility between me and Dr. B., and if for any reason my case turns complicated enough to need his expertise, it’s fine with me to call him in.  The same day, and quite independently, Dr. B. told him the same thing.

All’s well that ends well.  And my case is not going to be that complicated.

I’ve been through the second bout of radiation now, the direct implant.  Some of you have asked why, after the doubts I expressed, I decided to go ahead with this step.  I didn’t explain it very well last month, because I don’t really have a good explanation.  I could find no statistical evidence that it would either help or hurt me.  I’m pretty sure that it’s medical overkill.  I guess my various doctors collectively convinced me to be more afraid of the cancer than of the radiation, and to see that not only their minds but my own would be more at peace if we knew we had done everything we could to knock the cancer down — even if none of us are sure what’s actually happening.

The implant was a minor surgical procedure.  Surgery begins at the hospital at 6 AM, so Karel got the pleasure of driving me to Hanover through a wild and woolly (and beautiful) blizzard at 5:30 in the morning.

It was interesting to go through the rigmarole; a practice run-through for next time.  First they line up all morning’s operatees on stretchers in the recovery room and insert various tubes for IVs and things.  The anesthesiol-ogists come along and check to be sure all hearts are still pumping.  The patients lie there in a row and make morbid jokes.  Then one by one each patient is wheeled through the corridors (a dizzying experience) to an operating room.

I had an epidural anesthetic that knocked me out only from the waist down, so I was more or less awake, though I remember little from the operating room — only how funny the doctors looked in their masks and caps.  (Both were there, Dr. T. the radiation oncologist and Dr. S. my new gynecologist.)  The procedure didn’t take long — it was simply the insertion of three long metal tubes, one into my uterus, the other two up against the end of my cervix.  The tubes were packed in with gauze and held by a couple of stitches to be sure they wouldn’t move.  At this point they held no radiation.  The orderly announced to one and all as he wheeled me out, “She’s not loaded yet!”

Then to the recovery room to monitor my vital signs as the anesthetic wore down.  Then to X-ray to make an image of the exact placement of the tubes.  That image was fed into a computer, which calculated precisely how many hours the radiation had to be in place to deliver the right number of rads to various spots in my pelvis, given that the penetration falls off with the square of the distances from the three sources.  Pretty clever stuff.  Here I go, getting fascinated with the technology again.

I don’t know if I’ve explained that all this radiation, both the external-beam and the implant, is to knock out any cancer that may have spread into my abdomen, especially into the lymph nodes.  There is no evidence of trouble there, but it could be microscopic and undetectable.  They do the radiation before the hysterectomy because they can make the dose larger then; the uterus somewhat protects the bowel and bladder.  Another reason to do the radiation first is to knock back the main tumor, which will greatly reduce the chance of spreading cancer during the hysterectomy — which will, of course, finally remove the tumor.

They wheeled me to a private room — since I was about to become a living radiation source, no one was allowed to come close to me.  Dr. T. arrived to “load” me, trundling a little lead box on wheels, out of which he pulled three slim wands, like unlit Fourth of July sparklers, each with a charge of Cesium-137 at its end.  He stuck the wands into the three metal tubes, fixed them in place so they couldn’t move, and disappeared.  After that visitors could stay only for short times and were kept on the other side of a big lead shield.  Nurses had to dash in and out.

There I lay, a living radiation source, for 26.5 hours (the time calculated by the computer).  I had so many wires and tubes attached to me that I couldn’t have moved even if I wanted to.  There were the three metal tubes in my vagina, and a catheter coming out of my bladder.  An IV dripped into one wrist, and the epidural anesthetic dripped into my back (the drip was turned down so that I was no longer numb, but I felt no pain).  Three electrodes were pasted to my chest, wired up to an apnea alarm, which would sound if my heart stopped beating or if I stopped breathing (necessary because of the anesthetic, I guess).

Best of all were the wires I attached myself, two cheap Sony earphones, connected to a little Discman CD player, into which I fed Schubert and Beethoven and Puccini’s Turandot and Mozart’s Magic Flute.  I spent a good part of the 26 hours on the stage of the Vienna State Opera singing all the parts.  The poor nurse would peek in to check on me and hear, “Ein Vogelfaenger bin ich ja, stets lustig heissa hop-sa-sa!”  There could not be a better opera to listen to, flat on one’s back in a hospital bed, than the Magic Flute.  Turandot’s pretty good too — a tale of love conquering all.

So the time passed.  Hospital food is wretched, they keep waking you up to give you pills, you’re a little too groggy to read, the walls are a nauseating green (why, why, why do they do that?), the small of your back gets pretty tired of being underneath you, and it’s lonely with a lead shield between you and the world, but with Mozart et al. anything is bearable.  Precisely 26.5 hours later the blessed Dr. T. reappeared with his lead wagon, slipped out the Cesium, unstitched and unpacked me, detached the tubes, and sent me home.

I was sore for a few days and tired for a few more, but none the worse for wear.  This bout of radiation was much easier on me than the external beam.

Meanwhile the director of the cancer center had sent me a letter objecting to the column I wrote comparing radiation therapy with pesticides and invasions of small nations.  I wrote a long letter back defending my point, using his center as an example.

I told him the center was technically terrific and humanly deficient.  I made a specific list of what I wished the center had done for me — including appointing an ombudsman to guide me through all the confusing procedures, being sure there’s a talk with a dietician, making the medical literature available upon request, and providing information about the cancer support group and strong encouragement to join it (more about that group in a minute).  I also said the doctors should show up on time for appointments, read Bernie Siegel, be more upbeat and much more informative with patients (without being dishonest), and be better supported themselves, so their personal hassles don’t spill over into their professional lives.  I offered my partnership to work with him in any way I could to make those things happen.

What I didn’t know when I sent off the letter was that the director himself had just been diagnosed with cancer.

He sent back a wonderful answer.  He didn’t necessarily agree with all my points.  I guess he takes the medical view that a cancer is just a random cell-division-gone-wrong technical problem, not a mental or emotional or spiritual one.  But he circulated my list through the administration.  And he suggested that we keep writing to each other, exchanging views, and sharing our mutual adventure of, as he put it, “cancers that will in all likelihood be cured, not without some difficult times for both of us, and not without leaving a track of what we have been through etched on each of us and those around us.”

I feel honored and excited by the possibilities of this correspondence.  As someone who will now experience the disease from both ends of the stethoscope, as it were, he will be in a perfect position to transform cancer therapy, to bring in all human powers to the task, not just the powers of intellect and technology.

His own center will be easy to transform.  Everything that is needed is there.  I finally have had the energy to get to the cancer support group, where I found much of what I’ve been looking for.  People who will let their hearts and feelings show — patients, nurses, chaplains, social workers.  Literature and tapes on positive thinking.  Tips on nutrition.  Advice on how to deal with insurance companies and doctors and families and employers.  All this is volunteer activity, perking away in a corner, not visible or official, not respected by the doctors, but there.  (Newsweek says that patients that go to a cancer support group have double the survival rate of those who don’t!  Why doesn’t the medical profession sit up and take notice of statistics like that?)

There are no posters or brochures about the support group in the oncology or radiation therapy waiting rooms — and, I now know, there ARE posters and brochures.  So I went around one day distributing them where they should be, in the halls and waiting rooms where I know outpatients go.  I’m going to get to the nurses, if I can’t get to the doctors, to be sure that newly diagnosed patients are urged to attend the support group.  And I’m trying to get meetings to happen more than once a week, some in late afternoon or evening, so working people can go.

I don’t know where any of this is going to lead, but as you can see, I’ve been sucked into a new crusade.  If I can spare even one other patient the confusion and frustration that I’ve been through trying to find my way around the weird world of cancer care, I’ll be happy.

Actually, I’m happy already.  I feel like I’m making a positive difference for myself and others out of an experience that I first viewed as a total Time-Out from Life, a lost period, a waste of six months.  How little I knew!  I defined “wasted time” as any time not spent writing or doing farm work.  I couldn’t imagine value in time spent learning about illness, learning about my body and myself, getting mad at the medical system, sharing and listening to others share, or just plain “letting go and letting God,” as they say in OA.  So much for my valuation of time and my ideas about making a difference.  There are unimaginable opportunities in the most unlikely situations.

I wish I could say that I have been humbled enough to get that point finally and permanently.  But I haven’t been.  As I write this, I have gone three whole weeks with NO MEDICAL CARE.  The doctors say the cancer cells have responded well to the radiation — meaning they have been knocked back.  I can feel the good cells recovering as my body slowly moves toward proper functioning again.  I’m off all medication.  (What a remarkably resilient thing a body is!)  I’ve regained much of my normal strength and all my old habits and expectations.  With the return of my appetite I’m fighting my battle with overeating again.  I’ve been pushing myself to work full days at Dartmouth on the book and even venturing a few evening meetings.  When it turns out that I’m still not up to that and I get overtired, I turn discouraged and grumpy.  Already I’ve returned to being more upset about the things I can’t do than grateful for the things I can.

Do you think I’ll ever learn?

Well, maybe I will; we’re not finished with this journey yet.  Surgery is scheduled for March 6 — and that should be the LAST STEP.  I should be in the hospital (listening to opera) for 4-5 days and recuperating at home for a few weeks thereafter.  I intend to work during that time on my other book, a collection of my columns for Island Press, which just needs a little editing and glue.

And then it will be time for pruning fruit trees, lambing, and fixing fences.  I’ll be ready.  And I’ll be praying to be nonjudgmental and patient and grateful.

Love, Dana