Surprises at the City of Hope

My follow-up visit at CofH today included a blood draw, a consultation with Dr. Forman, a mini chemo infusion and at least two surprises.

I was surprised to learn from Dr. Forman that my white blood cell count, which was drawn last Friday, had plummeted from 1,000 to 400. Dr. Forman was concerned enough that he thought about calling me at home last weekend. The surprising thing is that I didn't feel "fatigued" at all. As a matter of fact, I had an active weekend that included a dinner party on Saturday night (thanks, Debbie!) and a large gathering of Andrew's family on Sunday. I've taken time for "resting" during the day, but haven't napped once since I checked out of Hotel Hope a week ago. It's encouraging to see that I'm still feeling energetic in spite of the white blood cell dip. I received an inoculation to help me keep the count up during the next round. (NOTE added July 2007: At the time I wrote this, I didn't understand that white blood cells have nothing to do with fatigue.)

While scheduling my next appointments, I spotted City of Hope CEO and President Dr. Michael Friedman, a diminutive but dapper man in a trademark bow tie. He stopped to chat with a volunteer and then with Dannie, my scheduler. I thought about introducing myself to him, but didn't want to be presumptuous. The next thing I know, he's introducing himself to ME because it turns out I'm the person he's looking for.

My friend Barbara R., who is on the Hillside's board with Dr. Friedman's wife Libby, is responsible for the connection. He said that he tried to visit me while I was an in-patient, but I had already checked out. Cindy, Andrew and I sat down and chatted for several pleasant minutes with Dr. Friedman. When he asked how I was being treated, I told him that I had the best doctor in the house. He disagreed and said that Dr. Forman isn't just the best in the house; he's one of the best in the world. I did tell him that I'd experienced a couple of administrative snafus along the way, but everything was satisfactorily resolved. He gave me his card and asked me to call him personally if anything ever came up.

It was no surprise that Dr. Friedman, like Dr. Forman, seems to be that rare combination of genius and graciousness.

The Right Size Bag for the Right Size Job

I worked my first job as a cashier at Cope Super Market in Ravenswood, West Virginia, decades before the "paper or plastic" era. In 1971, brown paper bags came in five standard sizes to accommodate everything from a piece of Bazooka bubble gum to a 25-pound turkey.

One of the first lessons I learned from the co-owner, Garland Cope, was, "Use the right size bag for the right size job." I was a penny-pinching high school student, but I couldn't understand why Mr. Cope, one of the richest men in town, zealously adhered to this mandate. If he witnessed one of his cashiers using an inappropriately sized bag, he would leap from his office perch and select and substitute the proper brown bag. (This only had to happen once before I learned the lesson.)

A few years later, in my early 20's, I began to understand that Mr. Cope's obsession transcended dollars and cents. I applied the lesson of using the right tool for the right job to my first elementary school teaching job. Some kids needed a whisper; others required a stern voice. Don't ever confuse who needs what.

Mr. Cope's maxim has served me equally well over the years through a mixed bag of careers: teaching, marketing, parenting and freelance writing and editing.

When I began to explore my treatment options for Mantle Cell Lymphoma (MCL), I could once again hear Mr. Cope's admonishment crackling in my ears: "Use the right size bag for the right size job."

Was Rituxin + CHOP (R-CHOP), a chemo protocol that had become the gold standard for MCL, the right bag? Would going for the more aggressive, intense approach - Rituxin + Hyper CVAD + Stem Cell Transplant - be like putting a piece of bubble gum into a turkey-size bag?

In my case, it became relatively easy to choose the right bag. Not only did the world-renowned Dr. Stephen Forman at the City of Hope make a case for Hyper CVAD, but MD Anderson Cancer Center agreed. MD Anderson also revealed that my cells are of the "blastic variety." There are three subsets of cells associated with MCL, and blastic is what you DON'T want your cells (or your children) to be. They're stubborn, aggressive and treatment resistant. At one time, in the not too distant past, this diagnosis was a death sentence.

But MD Anderson quickly countered the bad news with some good news. My written second opinion included the results of a 2006 MD Anderson study that announced that MCL patients with blastic variety cells have had excellent outcomes with the Hyper CVAD protocol.

R-CHOP would have been like taking a pop gun to a charging rhino. Or, to put it into Mr. Cope's vernacular, like trying to stuff a 25-pound turkey into a penny bag. Hyper CVAD + Stem Cell Transplant, on the other hand, appears to be the "right size bag for the right size job."

I think Mr. Cope (who passed away in 2006) would have been pleased with my decision.

(Do any of you have a Mr. Cope in your life who taught you a life-long lesson at an early stage of your work life? Please share in comments.)