4-24-10

Everyone has been so generous with their thoughts and good wishes.  I read every email with great enthusiasm, and each one has been invigorating to my spirits.  I hope it’s understandable if I don’t respond by email to each one individually, but I do so with my heart.

Status: 8.75/10.   Little worn out from all the trips back and forth yesterday with drug-induced GI distress.  That Imodium guy deserves a medal.

Events: No chemo today.  The continued blood drawings have lowered my red cell count to the extent they need to give me 2 more units of blood today.  Reminds me of a fraternity party we had in college with the requisite beer consumption (long before the enforcement of underage drinking).  One of my fraternity brothers was consuming his fair share throughout the evening, and late that night after the party was over I saw him in the bathroom standing over the urinal, head leaning against the wall, and pouring a can of beer into it.  Astounded, I asked him what he was doing.  And with remarkable perception percolating up through his inebriated haze he said, “I’m eliminating the middleman.” I’m just the middleman between two of Hopkins’ laboratories.

   My white cell counts have dropped dramatically as well as the number of my platelets from the chemotherapy.  The medical team says, “As we expected,” but the numbers are a little shocking to anyone who doesn’t see oncology patients every day.  The normal platelet count is 140,000 – 400,000 per cubic centimeter (that’s a 1/5 of a teaspoon to you and me), and mine are down to 15,000.  If they drop below 10,000 (as they’re sure to do) they’ll give me platelet transfusions.

   Lisa and Ethan came up this morning.  Rachel was brought up by dear friend Wendy Yaross this afternoon.  We’re listening to Tchaikovsky’s 5th symphony and Chariots of Fire – that’s a great day by any standard.  They’re such creative and talented kids.  Both are incredible writers with insight and nuance.  And Rachel’s poetry rivals any laureate – way beyond her years in maturity and awareness.  I remember when Ethan was just 7 or 8 and remarked that something was, “As quiet as a cul-de-sac.”  Awesome.  

Comments: The 3 main components of blood (red cells, white cells, and platelets) can each be individually separated from whole donated blood using a number of methods differentiating them based on their weights.  If you take a sample of blood collected in a tube with some anticoagulant and then spin it in a centrifuge you’ll see a bottom portion of packed red cells (representing the donor’s hematocrit), a top portion of straw-colored plasma, and in between, floating atop the red cells like the mist in Macbeth, a gossamer-thin layer called the “buffy coat.”  It’s mostly composed of white blood cells.  Of course, real separation is a little more sophisticated but based on the same principle.

  If you look at a stained blood smear under the microscope the platelets are tiny violet-colored little “plates.”  I was astounded the first time I saw a bag of platelets hung on an IV pole readied for transfusion.  They weren’t violet at all (duh!).  They have an ethereal, peachy-orange color – close to the sky just before dawn.  [And as an aside, that reminds me that I read a physics article once that said researchers were able to determine the color of an electron.  Yes, that’s right.  If you could collect a bunch of electrons together they’d look blue.  Blue.  Isn’t that remarkable.]

  I’ve always been intensely affected by color.  And that almost overbearing sensitivity has been frustrating at times for Lisa when we’ve had to pick out fabrics or furniture.  I’d say I didn’t like something because it was too brown or not green enough, and she’d say, “Ignore the color, we just need to know if you like the shape.”  But I was always unable to separate the color from the task at hand.

  My favorite artist is Monet, and I’m just crazy about his late works that are strikingly wild splashes of color.  Some have speculated that deteriorating eyesight may have been responsible, and that was the way he actually saw the world.  If so, what an extraordinary gift from a disability.

  And one last remark about color.  While I was reporting medical news for ABC in Chicago (perhaps the best city in the U.S. if you discount January and February) I was asked to audition to be the host of Newton’s Apple, the science series on PBS.  The host reads a question sent in by a viewer, and then proceeds to have an expert answer it and expand upon the topic in a fun-filled and engaging half-hour.

   The program’s producers would screen the audition tapes with an audience to see if they liked the potential hosts.  Turns out I didn’t get the job, but I’ve always smiled with some satisfaction after the producers told me why I wasn’t selected.  They said, “We thought you were great and would have picked you, but the audience didn’t find you believable asking all those naïve questions, they were sure you already knew the answers.”

   Although I lost out on the hosting job, I was asked to be the medical “expert” for the show, and had a great time appearing on the program for 5 years.  The program I most enjoyed was entitled, “Why is Blood Red?”*

  I don’t have all the answers yet for the current episode in which I find myself, but I’m sure I can figure out how to ask the right questions.

 Looking forward to another good day tomorrow with Lisa and the kids.

Love,

-Bruce

* The answer to the question is that blood is red for the same reason that rust is red – iron oxide.  The iron in your red cells’ hemoglobin combined with oxygen gives it its characteristic crimson color.

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12 Responses to “”

  1. wendy Says:

    B- at this rate with all your colorful descriptions, I will no longer have to try to explain what you’ve done over the years and what kind of doctor you are……cause answering that question has always been quite a challenge.. I’ll just pass on your Blog…and say-yep- that’s my older brother, he got those Bespalow “Genes”…while I’m not sure whose I got…

  2. Bill Israel Says:

    Hey, Bruce —

    Eileen and I are on the couch, reading your latest, and not trying very hard to restrain our guffaws over your being the middleman. That episode with your fraternity brother puts me in mind of the Great Pink Catawba Drunk of Christmas 1970, whose details I’ll spare you, at the moment — but drifting over the potty surely brought it back.

    How great to have the family, music, and some good time together. And what spirit you have – not only to endure all these indignities, but to be willing to share them with the rest of us, who love you. And so, Newton’s Apple continues, updated. We’re glad to be part!

    Love from us both —

    Bill and Eileen

  3. Judi Golding-Baker Says:

    Hi Bruce,

    I smiled at the end of your entry tonight — I couldn’t remember why blood was red — and I thought as I hungrily read (and I do mean “hungry” in the sense that I find myself so grateful for your words, your reflections, your take on things…you are so generous with your “food for thought…”) In any case, I smiled at the end when you answered the question…

    Also, I’m so happy you had time with Ethan and Rachel today.

    I’m sending you a hug and kiss, and hoping you get some rest tonight.
    Love you
    Judi

  4. Peggie Neill Says:

    You have not been far from my thoughts, or my wishes to change the situation for you. Which in turn has yielded a colorful bloom of memories of crazy times in EIS.
    I have two little folk art figures on my kitchen windowsill; the window looks out at a pond. I put a small bunch of violets in a vase (that’s for your love of color) on the windowsill. The figures are Noah with his ark, and Jonah with his whale. Their message is for you to have faith; they did.
    With love and prayers,
    and all my concentration to levitate your counts up,
    Peggie

  5. Donna Hill Howes Says:

    Thanks for the smile on my face just thinking of the kids surrounding you with love and wonder and spirit….you richly deserve to be infused with that energy each and every day!
    And I knew we had something more than just our love of health ed in common….I’m a big fan of Monet too! Fine art and classical music….doesn’t get much better than that.
    Enjoy your tomorrow with that sweet family of yours.
    I’ll be in D.C. in 2 weeks and will ring you to see if you’d be up for a short visit from a nurse. XO to you and Lisa. Donna

  6. Hope Dan Says:

    I can’t compete with all he wonderful words from your friends and family, just glad we share the same Genes! And guess who gave them to you!

  7. Johnny & Lake Says:

    Dear Bruce,
    As always your ‘Reports from the Front’ fill us with awe, inspiration and heartfelt love for you. Your courage is remarkable, but so is, your brilliant communication and writing!! Both of us can picture very well Bruce Dan aka Peter Seller’s and a flapping gown or the mad flock of doctors/students doing their ’rounds’ with professionalism but a little less (or a lot less) empathy and straight-talking. As the UK is far behind in matters of good-looking doctors on tv, we never had the chance to witness your 5yr stint as Dr Dan, but if these little missives are anything to go by, we’re certain you just rocked the ratings off the charts. Meanwhile, and apropos your comment about the colour blue and electrons, did you know (well, given you, I’m sure you do know!) that, as recently relayed by satellite, black holes ‘whistle’ – and they do so in the key of B-flat!!
    We love you, and love also and always to Lisa, Rachel and Ethan too xxx Johnny

  8. Hope Dan Says:

    Would love to know something and somewhere about alll these wonderful people that write their comments and love to you.

  9. Lynn Oliver Says:

    Dear Bruce,
    I am at a conference in Vancouver, BC and just left the opening talk on “The Physician as Patient: Lessons From the Other End of the Stethoscope.” It so paled in comparison to your wit and wisdom that I came back to my room to read you instead.

    I loved your description of teams rounding–said much better than the broken record I play to students (who probably don’t know what that means) about–tell the patient who you are, what your role is, what is going on, what your thoughts are! Don’t be remote! And if it’s a serious talk, don’t have 20 people come in the room lording over the vulnerable person in the bed… Ask him/her–how ARE you? And really mean it. And listen. (One of my former students, now a resident, who recently underwent chemo said he will never again write “the patient tolerated it well..” He said, “that means you didn’t die or get transferred to the ICU.”) Oh, but our culture is deeply ingrained isn’t it.

    Knowing you, your team is learning something from you–delivered with grace despite being under fire.

    (How many times have you been asked..”on a scale of 1 to 10….”)

    Altho it sounds trite I cannot believe you are there doing this…I know (well, in the same sense that you can be a feminist but not have a clue what it is like to be a woman) how people (appear to) feel going thru this, and I am marveling at your ability to keep your words coming–funny, thoughtful, informative, entertaining…

    We are far away in miles, but not in thought. I’ve known Lisa since I was 8 years old–a 45 year bond which deepens my connection to you despite the relatively few times I’ve had the pleasure of actually being with you. (Camping has that effect too!) How lucky I am to know both of you!

    Sending much love, and blue electrons too. I like that image. Love, Lynn

  10. Taylor Howes Says:

    Bruce,

    I just want you to know that all of my thoughts and prayers are with you and your beautiful family during this tough time. Let me know if there is anything I can do to help.

    All My Love,
    Taylor
    Xoxo

  11. Lulu Falls Says:

    Thank you so very much for your blog. I just found it so I’m a bit behind, but already I have learned and laughed much.
    I had Acute Myloid Leukemia with undiferentiated tendencies (according to my wonderful doctors at Norris) and Acute Biphenotypic Leukemia (per my wonderful doctor at UCLA). Six months in the hospital, induction, consolidation, two abdominal surgeries to remove infection in my intestines, and a Bone Marrow Transplant (allo; brother; CMV incompatibility; 6/6 HLA).
    Yes, almost 13 years since the transplant on 7.4.97, and I’m still here to tell the tale.
    I always wanted to write and take video of the experience, but since I was diagnosed at the edge of the cliff (hard to diagnose, down to a few red blood cells) I was too sick to do so.
    Well, I’m grateful you’re doing it–you’ve taught me a great deal already, and make me laugh, laugh, laugh.
    You and your family are inspiring in many ways. I send my love, prayers, and hope to you and yours. Love to my favorite candidate, Lulu Falls, LA, CA.

  12. alexxus,aileen luna Says:

    i just read your story in the monitor we were eating and my mom was reading it to us and she started crying. we decided that we are going to talk to are teachers to see if we can help you, by getting people to donate blood. loving u in Mercedes TX

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