I'll have a side of fatigue with that chemo.

After my doctors at City of Hope first recommended the Hyper CVAD protocol, they immediately cautioned, "You'll need to quit your job." I was led to believe that the side effects of this dose-intense chemo would be so debilitating that the most I could expect to do was watch "I Love Lucy" reruns while eating rice gruel.

Imagine my delight when I sailed through Round 1 (Course A) with few side effects. Best of all, I had the ability to lead a full life during my two-week home pass. I drove myself to doctor's appointments, shopped, ran errands, made dinners, met friends for lunch and brunch, did laundry and kept the house picked up, went to several dinner parties and a Dodger game, attended a Japanese cooking class, did Pilates classes on Tuesdays and Thursdays and yoga on Saturday, walked regularly, gardened, completed some work for my former employer, attended two writers meetings, helped out at a Hillside's event, paid bills, did a lot of reading and writing and, occasionally, took a nap. I know this sounds like a lot, but I felt like I was doing a good job of pacing, not pushing, myself.

I didn't fare as well after Round 2 (Course B). I checked out of Hotel Hope on Sunday and had difficulty pulling myself out of bed on Monday to take Cindy to school and make it to the CofH by 8:45 for my blood draw and shot of Neulasta (to increase white blood cell counts). (George usually takes Cindy to school now, but since her school is on the way to CoH, I took over that morning.) By the time I got home, it was nearly noon, and I gave myself the rest of the day off.

On Tuesday morning, I felt a little better, but was disappointed that I couldn't rally to attend my 9 am Pilates class at the Pasadena YWCA. That evening, I managed to make dinner and took Cindy to her confirmation class. I noticed that I felt winded while puttering around the kitchen and that my heart rate shot up after I walked up a flight of stairs.

I feared that I wouldn't be able to pull myself out of bed again on Wednesday and rescheduled breakfast with a friend. I managed to take Betty to her grooming appointment, picked up the house and did laundry, but it took a toll. After I walked from the basement laundry room to the second floor, my pulse jumped from 60 to 120. I took a quick nap before my friend Ellen arrived that afternoon from Colorado.

I was so happy to see her that I felt my energy surge. We walked two and a half blocks downhill to our swim club. But I was a "big bad wolf," huffing and puffing for the entire two-flight stair climb and 2.5 block uphill return trip home. Again, I needed a nap to recover.

But, once again, I bounced back and we had dinner out.

By Thursday morning, I felt that I had completely recovered. I picked up Ellen at her hotel in Old Pasadena so that we both could attend the 9 am Pilates class. The teacher was out ill, but we took a short walk and then did our own workouts. I stretched while Ellen did an energetic NIA dance routine. When KC and the Sunshine Band started blaring, I jumped up and improvised a high-energy, 7-minute dance routine. After all, who can resist "Shake, Shake, Shake" and "Get Down Tonight"?

I dropped Ellen off at her hotel, came home to shower, and then picked her up for lunch out and appointments at the CoH. When I missed the exit and then got lost on the way to lunch, I blamed "chemo brain," but I knew full well that I was like this before a single drop of chemo surged through my veins.

I was still feeling full of energy when we arrived for my 1 pm blood draw at the CofH. As I mentioned yesterday, I fully expected to learn that my blood counts (red blood cell, white blood cell, hemoglobin, platelets, etc.) had soared through the roof.

I was shocked to find out that all my counts were in the toilet, and Dr. Forman was even more shocked to learn of my activity level.

Now it's time for a chemo side effects refresher. The chemo is designed to attack those nasty, fast-growing, blastic-variety Mantle Cell Lymphoma cancer cells. It is doing an excellent job at this, but, at the same time, is indiscriminately attacking other fast-growing cells. The attack started with the hair follicles and then moved on to the skin cells (my skin is full of unhealed sores) and every component of the blood cells.

When my white cell count drops, I'm especially vulnerable to infections. A drop in red blood cells causes anemia and assoicated fatigue and irritability. The drop in hemoglobin (a component of red blood cells) explains the shortness of breath and elevated heart rate. (I had to review how the hemoglobin - the oxygen and CO2 carriers of the blood - tie in with the heart and lungs of the circulatory system.) A fall in platelet count is worrisome because these yellow components are responsible for blood clotting.

My white cell count should recover soon because of the Neulasta shot on Monday, but my low hemoglobin and platelet counts called for that Thursday afternoon blood transfusion.

Again, I don't understand why I felt so good on Thursday in spite of the low counts. I compare it to my "fearless" attitude when it comes to people and places. I'm missing that piece of DNA that makes others naturally suspicious. Over time, my brain, not my gut, has learned to pick up on danger signals, but it doesn't come naturally and sometimes may miss a beat. For example, many of the female tenants in our Old Pasadena office building felt threatened because a homeless man had taken up residence in the fenced dumpster area of our parking lot. Some reported him to the landlord, but I felt he was harmless and covertly left blankets by the dumpster.

If my gut and my body don't naturally tell me to SLOW DOWN, I'll have to rely on other signals, such as lab results, pulse rates and help from family and friends.

Last week I reread a 2003 Time story about West Virginia war "hero" Jessica Lynch. I particularly liked this quote: "When it's all over," says her father Greg Lynch, "she'll just be an old country girl"—the label a shorthand for the virtues that matter, like kindness and toughness.

I feel the same way about this chemo process. When it's all over, I'll still be a kind and tough country girl, but I just have to make sure that the same tough quality that will get me through doesn't kill me in the process.