Hanging around

It was a little over two years ago that I discovered I had cancer, and there was a period of a few months where each week or two seemed to bring a more ominous parcel of news: myeloma is classified as incurable, or, in the delicate phrasing of Blue Cross/Blue Shield, "inevitably fatal"; various of my bones, notably my back, ribs, long bones, and skull, have "innumerable" lesions (aka holes); the tumors have a specific "high risk" mutation that disables (actually destroys) TP53, the "guardian of the genome" . . .

I'm not given to drama, but it's a lot to take in out of the blue. It's also a lot to unload on other people, especially family. Liz has had to absorb this on a daily basis, of course, and has been there for every single office visit (there have been many, many office visits) and the vast majority of the infusion sessions, biopsies, line insertions (and re-insertions) and removals, C/T scans, MRIs, dietary assessments, apheresis sessions, discussions of my bowel movements, nausea, etc. Not to mention much travel back and forth from Rochester, Minnesota by air and land. Liz has done all of this, dealing with the coming reality of life without me (not to overrate my contribution, but after 30+ years the change at least will be daunting). Meanwhile, she has been subject to years of cruel abuse both from her (and my) former department chair, and from, of all people, our son's girlfriend (or, as he says, "partner"). Why exactly the abuse rains down on her is a subject for another blog or two (coming soon). But it's real, it hurts, and I've been no real help.

Most people (excepting those special cases noted above) are shocked, sympathetic, at a loss, when news of this sort is presented to them. I know the feeling from both sides now, and it's real, too. After a little while, I realized that if I told my story to someone new, it was more stressful for the listener than for me, since I already knew the story. But a story wants to be told, and I probably have told my story more times than I needed to. Here I go again, for instance.

Two years out, there's little obvious drama. Although it's still not curable, the disease is stable now, and might remain that way for quite awhile. I will admit that I have often checked my watch during the flat part of a movie. Or at almost any moment in a French movie. The lack of drama is sometimes almost disappointing to me, which is really stupid. Drama will do me no good. Yet there is this vague but insistent feeling that I should be doing something, fighting something. I've said before that a cancer patient is the battlefield, not the soldier, so fighting cancer is not an option, not really.

What I should be fighting is the injustice and ignorance in the world. Nothing to do with my health, which has to this point been as privileged as any cartoon version of a 21st century white man would have it be. One part of the exams that my class of anthropology majors faced in 1980 was a response to  "Reinventing Anthropology," a book from the early 70s that confronted us readers with a full-in-the-face onslaught of raging cultural, political, and ecological problems [the later 70s on college campuses, for those who weren't there, was a relatively soporific period of sex and drugs and rock and roll mostly devoid of the drama that accompanied the civil rights and anti-Vietnam war protests of the previous decade].

Confronted at age 20 by my professors with the realities of the world, and with little experience of real world politics, I must have sensed something about myself that has held true over the almost 40 years since: I have no ability to convince other people to change their behavior. Trust me, there have been ample opportunities to test this. Results have been consistent. I don't think my arguments have been especially weak, but I do not often close the deal when the people on the other side have other ideas. I must have known or suspected this at the time, because my proposed solution to the problem of the world going to hell in a handbasket was not dependent on persuasion. It was to lead by example, or rather by structure. Self-sustaining communities, intentional cultures built around shared (appropriate) goals, seemed to me to be the best way forward. These could be families or something larger, or really large families. At the time, I didn't really know what a really large family was, but I have learned a great deal since I was 20.

For better or worse, Liz and I have not ourselves raised a really large family, although a really large family has been a part of Liz's world since she was a child, and a part of mine since I met her. Instead, we raised a little tiny family of two children in a house too big (and too geologically unstable) for sustainability. We've had to travel great distances for many years to keep being part of the bigger families of which we are members, and while we do that happily, the sustainability of the model is suspect. As it happens, one of our two children has found it necessary to sever his ties with us. So even the mini-model of community is beyond me, it seems.

Hell in a handbasket? Seems like we're going there fast. You can get a t-shirt. I'm still no good at persuasion, Q.E.D.

The Annual Review

I'm more than a little tardy posting this update, as it's been almost a month since we visited Mayo for a follow-up visit. The main news is that all is relatively well. In fact, not much of anything has changed meaningfully since last November.

The kappas are actually in the normal range now, and if only the lambdas would get back up into the normal range, the kappa/lambda ratio might be closer to the magic 1.0 (it's bouncing between 4 and 6 now). The official line is not to worry about the lambdas, since they're not the problem and their numbers are depressed by the chemotherapy. That makes some sense to me, but I think the "normal" range for kappa is probably irrelevant for myeloma patients for the same reason. It's good that the levels are low, because too much of that protein will cause organ damage, but it would be wrong to think (I think) that "normal" levels mean normal functioning. Probably I have about as much normal kappa as lambda, and the rest (3 to 5 times as much) is the bad stuff. All in all it's better to have less, and I have much less than I did two years ago (when it was several hundred times as much). So that's good.

There is no more bone damage apparent, although I have been driven slightly crazy by one comment in the radiologist's report: "the prominent lesion on the left scapula is unchanged." I have not been able to find any previous reference to a prominent lesion on my left scapula, and I just want to know where it is, mostly out of curiosity. Apparently it's been there awhile. I've been thinking that I'd like to try hitting some tennis balls after too many years, and (since I'm a lefty) I do want to know if my left shoulder is up to it. Don't really want to find out the hard way.

The only trend line that's really trending these days is my platelet count, which is going down. It hasn't dropped into a dangerous zone yet, but it means I bruise and bleed easily (always did, just more so now), so we're making a small change to the meds to see if that helps. My old friend dexamethasone is used to treat autoimmune thrombocytopenia (low platelets), but that probably has to do with its immune-lowering functions rather than any stimulation of platelets. Cutting down on aspirin (which I take to prevent blood clotting) seems like a good idea. It might not bring the counts up, but it should improve the clotting ability of the platelets that I do have, and the risk of unwanted clotting must be reduced if I don't have much of the stuff that does the clotting in the first place (that would be the platelets).

Reading all that, I think I've done my best to put a dark spin on a good report. I'm feeling good, staying active, riding 30-40 miles a week, and have all the support a person could hope for. Survival stats for myeloma patients keep improving, and some of the newer drugs will probably blow the previous results away. Mel Stottlemyre (look him up, kids) has been hanging in there for many years now, diagnosed in 2000, and he had it tough (chemotherapy-wise, at least). Lou Brock was diagnosed more recently, and now says he's "cancer free" (I'd beg to differ, but he is a Hall of Famer). I was a little too young to remember seeing them (if I did) on TV in the 1964 World Series, but it must have been a good one.

Speaking of baseball, at some point I want to review the Phillies' glioblastoma issues. More on that later.

Cures

A cure for cancer is like an alchemist's dream of turning lead into gold: basically a category error. You can't cure cancer because cancer is not one thing. There are lots of cancers, and each one is different in exactly the way you might hope to cure it. There are themes in cancer treatment, though, and right now the hot one is immunotherapy. Even that term hides a lot of variation, because our immune systems are really quite varied in their triggers and modes of action, and trying to get them to respond to an attack from within, when they have demonstrably failed to do so in the first place, is hard.

So right now, here is an incomplete list of promising immunotherapy approaches to cancer: 1) monoclonal antibodies; 2) checkpoint inhibitors; 3) chimeric antigen receptor T cells (CAR-T); 4) vaccines. Since every cancer is different (even every cancer called by the same name, like multiple myeloma) they don't all work on every cancer or even everybody with the same "type" of cancer.

Myeloma and other cancers that originate in the bone marrow (mostly leukemias and lymphomas) seem to be a little more responsive to all of these approaches than "solid" tumors like colon cancer or breast cancer. But everybody's cancer is a snowflake and some of them will just do stuff that defies the conventional wisdom. Recently there have been news reports about immunotherapy successes with myeloma and other cancers (and some major failures as well). Here's a status report, from my own perspective.

Monoclonal antibodies. Right now, two of these have been approved by the FDA for myeloma, Darzalex (daratumumab) and Empliciti (elotuzumab). [Every drug has a generic name (lowercase) and a brand name (Uppercase)]. At the moment, Darzalex looks like the more promising of the two, with some good long-term results.

Checkpoint inhibitors. The idea here is to defeat the mechanism that many tumors use to evade attack by the immune system. The most famous of these drugs is probably Keytruda, which has been very successful in treating melanoma (see Jimmy Carter) and has been the first drug ever approved by the FDA for a specific pattern of genetic mutations regardless of the tissue in which the tumor originates. Sadly, for those of us with myeloma, Keytruda trials have been halted by the FDA because of  a recent spate of patient deaths.

CAR-T. These are the current cutting edge of "personalized" cancer treatments. T-cells harvested from a patient (by apheresis) are engineered in a lab so that they have receptors for the specific antigens expressed by the patient's own tumor cells, and are then infused back into the patient. This can have spectacular results, but sometimes causes really severe reactions including sudden death. In myeloma, two recent (small) studies have had great results. I'm thinking hard about this option.

Vaccines. The idea here is to train the immune system to something that triggers a response against the tumor, so it's kind of like CAR-T, except it's in vivo. Early days here, stay tuned.

I am (we'll call it) lucky enough to be responding to the treatment I'm getting now (Ninlaro-Revlimid-dexamethasone), so there is no obvious reason to do something rash at the moment. There is a CAR-T trial at Mayo that is currently recruiting patients, and I think I qualify, so we will discuss this with the docs when we visit at the end of August. There are a few other trials that might be worth looking at, too. Some of these have nothing to do with immunotherapy, and that's not necessarily a bad thing.

Drifting off the point a bit: John McCain has been a warrior in real life, but he shouldn't be judged on his "fight" with cancer on the basis of how long he survives now that he has been diagnosed. As I've said before, a cancer patient isn't a combatant--he or she is the battlefield. We survive or not (not; it's only time that varies) largely as a function of things that we have no role or agency in: our genetic underpinnings; the accumulation of random mutations in single cells; exposure to environmental toxins that we can't see/hear/feel/smell/taste and that are not currently known to do us harm; exposure to things that we do know can cause harm but we can't possibly avoid (like cosmic rays and radiation from the earth's surface).

Cancer is not a moral failure

Back during the Cold War, cancer was often compared to communism, and vice versa. Seriously. It was during the height of those hostilities, in the early 1950s, that the British epidemiologists Richard Doll and Austin Bradford Hill published two papers that clearly established the relationship of smoking to lung cancer. Although the idea had been around for some time, many eminent scientists, most notably R. A. Fisher, were convinced that Doll and Hill had it all wrong.

Of course they were right. Sadly, Epidemiology, my chosen profession, has not had a similarly important contribution to public health since, and likely never will.

Another unfortunate downstream effect of the smoking - lung cancer story is that cancer has become associated in many minds with risky behavior. If you have cancer, you must not have lived right. This is bullshit, and a moment's thought will tell you so. The majority of smokers do not get cancer (although smoking certainly causes cancer), so even among lifetime heavy smokers only the unlucky end up with lung cancer, or bladder cancer, pancreatic cancer, or one of the several other cancers caused by smoking. Even among smokers who get lung cancer, a (very) small fraction have cancer for some other reason (genetic susceptibility, radon exposure, unknown causes, . . .), and among ex-smokers and non-smokers this fraction is much larger (100% of non-smokers, of course). 

Sometimes risky behavior is mistaken for immoral or shameful behavior. Smoking is risky, in the sense that it increases your risk of many diseases and death. Mountain climbing is risky, too, but is rarely viewed as bad behavior. So maybe the distinction has to do with how these behaviors affect other people, but that doesn't work out either: secondhand smoke does affect the health of those exposed, but bad mountain climbing decisions often lead to multiple deaths, and essentially victimless behavior such as overeating gets put in the "bad behavior" category a lot more often than it gets put in the "heroic but crazy" category.

The public health community would like you to know that avoiding risky behavior of all kinds is better for everyone, which is true enough, all else being equal. But strangely enough we all get sick and die, even epidemiologists, and how and when we die is only affected in part by how we have lived. How big a part our behavior plays is impossible to say given what we know now. The sum of our ignorance about the full set of events that lead to cancer or any other way of dying has to be counted on the "bad luck" side of the ledger, since we can hardly know to avoid something that we don't know can hurt us. 

There's a lot of bad luck out there. If you come up with an algorithm for avoiding it, you will have made the greatest contribution to epidemiology since Doll and Hill, at least. Also, you should buy a lottery ticket.

How to die, and when

Don't get all excited about the title -- that's just click bait. But in the absence of anything new to report as a patient, I'd like to step back a little and think about some life-threatening events in my past, how I slipped past them, and how those events compare to my current circumstances.

First, though, a little more justification of the title. I've had some memorable conversations with people over the years that start (in my version) with the other person saying something along the lines of: "that's the way I want to go -- all of a sudden, no warning [optionally: in my sleep]." My revulsion for this formula goes back to when I was very small and the prescribed bedtime prayer was 

Now I lay me down to sleep

I pray to God my soul to keep.

If I should die before I wake

I pray to God my soul to take.

That third line got me, and I renounced bedtime prayer just as soon as I was given enough privacy. Thankfully that was pretty young, maybe 4 or 5. I have never really reconsidered my position, so it may be the oldest continuously-held opinion I have: that I do not want to die before I have had a good long time to think about it, get my affairs in some kind of order, and say "Good-bye, I love you." to those who are still speaking to me. Thank you, multiple myeloma.

At first I thought I had three main events to recount in my past that might count as brushes with death. Then I remembered a few others, and realized that there were others, more numerous, with lower probability, some totally ambiguous, maybe some I never even knew about, etc. For example, there were a couple of spin-outs during my first year or so of driving (one on ice merging onto a busy highway, one in front of a dump truck coming down a long hill) that I hadn't included on my mental list. And one on a snow-covered road on the Red Mountain Pass in Colorado (look it up, if you haven't been there). Hard to evaluate how these relate to my continued existence, but I may be underrating them because they happened so quickly.

1. Those were near-accidents. One accident that did happen, and did happen quickly, was when I was a junior in college. Kenyon sits on what counts in Ohio as a Big Hill. On a beautiful Saturday afternoon in early October 1978, my friend Ethan and I were descending the north side of that hill on Wiggin Street on our bikes. Mine was an "English racer," with the classic trimmings: Sturmey-Archer 3-speed shifter, lugged alloy steel frame, caliper brakes, skinny tires. Ethan (a proud product of Ann Arbor-East Lansing-Detroit with loyalties to the glory days of American manufacturing) had a Schwinn (or maybe a Huffy?) with a curvilicious frame, a Bendix two-speed hub, and a highly suspicious paint job. My bike (no lightweight by modern standards) weighed maybe 30 pounds, and his weighed something like twice that. No matter, we were going downhill (see Gallileo). We were both smart enough to know that playing chicken wasn't a good idea, but subsequent events would show that he was smarter, or at least less dumb, than I was.

The events in question involved his left pedal being inserted between the spokes of my front wheel and my fork. This is a very effective way to stop a bike (mine). His bike remained quite stable. Meanwhile, I did not stop -- I flew over the handlebars (would have made a great photo or video if there had been anyone around to record it). What record there was, was written on my body, mostly in minor abrasions, except for my left hand, which was trashed. Bicycle helmets in 1978 were something you might have heard of but no one had seen one, let alone worn one. My head was doing about 30 MPH and heading straight for the pavement, when forces not directly under my control forced me to stick my left hand (the good one) out in front, and stiff-arm the pavement. I don't remember any of that, but there was a beautifully clear pattern of road rash from the hand up my left arm, across my shoulder blades, and down my right side that was easy to read. Meanwhile my head had not a mark. 

Ethan and I walked up the hill, about a mile, to the volunteer fire station. My left hand was bloody pulp, but I had just walked a mile up the hill, and the Ohio State - Penn State football game was on TV, so the firemen triaged me to campus security, who drove me to the local hospital ER, where all the appropriate things were done, most memorably removing embedded gravel with a wire brush. Ouch.

Villain: my own damn self. Hero: reflexes, Ethan, campus security (Reed, for those who were there). Long-term consequence: can't hold change in my left hand.

2. A slow-moving accident. Utah was a great place for accidental death. We avoided that, although not all of our friends did. Liz and a few friends had an ill-fated river trip, about which more some other time. I had enough sense/fear not to participate, and I was right for all the wrong reasons. One time that I failed to avoid danger -- indeed I was the prime instigator -- involved a desert backpacking trip in what is now (but might not be for much longer) the Grand Staircase - Escalante National Monument. I recruited Liz's brother Tim for a long weekend in Paria and Hackberry Canyons in early May. I had planned a loop hike up Hackberry and a side canyon, down into Paria and out. We came in late in the day, missed the mouth of Hackberry, and found ourselves hiking up what we deduced must be Paria. It was a beautiful hike, and rather than retrace our steps and go back to the car, we decided to reverse the route. The guidebook was written by a highly productive Canadian who had written dozens of trail guides to southern Utah but must have hiked so fast he wasn't great with details. The first night was great: camping in a side canyon of the Paria that was easy to find, gorgeous, and had almost no sign of human activity. In the morning, I was awakened by a VERY loud buzzing in my ear, and leapt up (reflexes again) thinking ground hornet, snake, or something terrible. It turned out to be a hummingbird checking out my ear as a possible flower. Day two we followed that canyon uphill, trying to find a "beehive-shaped rock" that would lead us across the high country. Turns out that every rock in the high country looks like a beehive (also there are a lot of bees). So we kept going up the canyon until it was clear that we had a problem. Water was getting a bit low. At this point, to my undying gratitude, Tim took over, and climbed (with full pack) to the top of the highest beehive and made me come up and see what he saw (I dropped my pack, however). Finally we could see our problem -- we had gone way north of the route we had selected, and had to figure out which of several deep side canyons to aim for (all but one of which were said to be "box canyons" without a survivable way in). It was a little after noon, hot, and there was no source of water in the high country. My cheery pictures of cactus flowers were becoming pictures of bones dried in the sun. Cue Ennio Morricone.

We chose a route that put us back in the general direction of where we thought we wanted to go. The closer we got to the canyon, the steeper the approach became, but we could see there was water down there. We tried several approaches, to no avail. Finally, Tim found a nearly circular wash head that looked passable, and we tossed our packs down and slid down the sandstone into a spectacularly beautiful side canyon, with a cute little stream and a healthy population of desert pupfish. We still weren't sure where we were. Eventually we worked out that it was Stone Donkey Canyon, one of the supposedly inaccessible box canyons, well north of our objective. From there, it was a nice long wet hike in the narrows down to where the car was parked, and, in one of those improbable (in Utah!) juxtapositions of need and fulfillment, a Navajo family pulled into the turnout as we exited Hackberry Canyon, and offered us cold beer.

Villain: my own damn self, speedy Canadian guy, geology. Hero: Tim, guy with beer. Long-term consequence: GPS?

3. Unintended consequences. I found I had MM in the Fall of 2015. By then, I had a lot of issues with my department Chair, and enjoyed telling him that I would not be available to teach in the next semester, without telling him why. I also told him that if he wanted to find the source of the low morale in the department, he should look in the mirror, and walked out of his office. He has not spoken to me since. The day after that meeting, I was scheduled for a session of chemo, with the attendant blood work. As it happened, my white cell count was basically zero, meaning that I had no useful immune system whatsoever. The hematologist thought that most likely I was having a reaction to one of the ancillary drugs (Bactrim), and that I should stop what I was doing and report immediately to the ER if I had signs of fever. Sure enough, a few hours later I started shaking like a leaf with a fever of 102. I was quickly admitted (not without a lot of questioning looks from everybody else in the ER who had probably been there for hours, nor without learning that my hematologist did not have admitting privileges to the hospital he had told me to report to). The next few nights I had continuous infusions of IV antibiotics and antivirals, fever dreams, and my general feeling that this might be the end. Daytime was better -- Liz and I were working on a grant proposal, and the isolation of that room was an unexpected bonus to the writing process, although I tired easily [the grant got good scores, but was not funded]. Another important plus was that Rosie introduced me to Words with Friends, a game we have been playing more or less continuously ever since (by the way, it's your turn). Dropping Bactrim has been effective in preventing and recurrences of the immune system crash, so it's all good (sort of) now.

Villain: Bactrim, RNB and KBB. Hero: Liz, Keith Carter (my primary care doc -- with admitting privileges), Rosie. Long-term consequence: new grant deadline strategy, new hematology practice.

In each of these cases, my destiny was completely out of my control, once I got to the point of near-, or near-near-, death. I am still confident that it's better facing an inevitable, but slow, path to death from cancer, even if I haven't yet accomplished much in terms of getting my affairs in order and telling all of those who need to know that I love them. But of course you're reading this -- I love you! -- Goodbye, if not just yet. More to come.

Cosmetics

The chemotherapy has settled into a regular routine now, 21 days of Ninlaro, Revlimid, and dexamethasone, followed by one week with just dexamethasone. So far, this seems to be working in the sense that the kappa (that's the protein produced by the tumor cells) levels in my blood continue to decline. There's still about 7 times as much kappa as lambda (produced by properly working plasma cells), though, so there's plenty of work left to do. While all this is happening, I feel good most of the time, and I've been able to get out on my bike quite a lot during this weirdly mild winter.

When I don't feel great, it mostly seems to be something related to the drugs. Besides the chemo trio, there is a set of old-lady-who-swallowed-the-fly companion drugs, to prevent or treat possible consequences of chemotherapy: an antibiotic (doxycycline), an antiviral (acyclovir), aspirin (to prevent blood clots), prilosec (to prevent heartburn induced by dexamethasone). And stool softeners and laxatives for the usual reason (also a consequence of dexamethasone). All this is just now a part of the daily cycle.

There are a couple of things that are puzzling, and we're trying to figure them out, if only out of curiosity. I've already mentioned the rash, which I blamed on shrimp. It turns out that even now that I am avoiding shrimp, the rash still occurs, then fades after a week or so, seemingly in relation to the chemotherapy cycle. Another cyclical feature is an obnoxious rosacea or acne-like condition that will overtake my nose and surrounding skin very quickly and disappears just as quickly. The rash is still mysterious, but the acne seems to be following a predictable pattern at this point, peaking during the last 7 days of the 28 day cycle, when I am taking only the dexamethasone. On the first day of the next cycle, I take the Ninlaro and Revlimid, and the sores disappear rapidly. Of course, I'd like to know which is doing the job, but what I'd really like is to find something I could use during that week to control the nastiness.

Less annoying, though peculiar, is the fact that my hair has become curly. I'm happy to have it back, and the novelty of having curly hair is fun, although I have no idea how to deal with it. Liz has helpful advice, of course--in fact, my hair looks a lot like hers now. We've been speculating about how this happens at the cellular level. It doesn't seem possible for it to be a genetic effect, because that would be confined to one or a few follicles. Instead, it seems that all the hairs on my head decided to become curly in unison--so the follicles must be talking to one another. Maybe there's some literature on this out there somewhere.

Full disclosure: I've had curly hair before, sort of--a mid-70's perm, which explains why I didn't get many dates in college. I blame Mike Schmidt for this epic lapse in judgement. Never mind.

The return of the shrimp

So I'm most of the way through the first cycle of post-transplant chemo, have my hair back (I promise to post a new photo soon), even had a haircut the other day. All the lab numbers are looking good enough--I could wish for a little more hemoglobin, and the kappa could go down further, but I am not complaining and feel pretty good. Almost all my current complaints are related to my old friend dexamethasone, and even those are greatly reduced by the lower dosage.

So it was a little alarming to find my torso, neck, and arms covered with hives a couple of days ago. It didn't feel like much, but it sure looked like something was going on. Fortunately, I had my monthly oncologist visit scheduled for the next day, and we figured we could discuss whether this was some kind of adverse reaction when we came in the next day. So we reported for duty at 7:50 AM, barely caffeinated, and went through the prelim paces (draw blood, insert IV tube, wait for labs, check vitals, check the med list, are you in any pain), and then I mentioned to the nurse that I had hives, just like I used to get when I ate shrimp . . . and Liz and I looked at each other and I don't know whose draw dropped lower.

I had been allergic to shrimp and other crustaceans since I'd had an arthrogram (involving a largish injection of radioiodine) at age 16, but the allergy had faded over the years and I had enthusiastically welcomed shrimp back into my diet, especially in the last couple of years. A great sustainable, highly nutritious source of protein, really easy to cook and mighty tasty to boot. Two nights before the visit, we'd made a (gluten-free, for those of you keeping score) pasta with a cilantro-jalapeno-lime-cream-shrimp sauce. It was very good, and I'd eaten leftovers for lunch the following day. What's more, the last night we were in Maryland after Dad died, I'd had shrimp and grits at a great restaurant in Frederick.

I will probably have no more. I'm guessing here, but I'm pretty sure that the stem cell transplants have reset enough of my immune system to have restored the old shrimp allergy. It's a minor thing, in context. I will remember those shrimp fondly.

postscript

We have been sifting through the memorabilia since my father died, and it's hard to keep straight what has been posted where. Just for the record, I want to put this photo here. It must have been taken when Dad was in high school (1944 or 1945, I guess). I think it has that mythic quality of old photos: all the thousands of images we can generate now, cropped, shopped, auto-tuned ad infinitum can't hold a candle to it.

In Memoriam

My father died last night. He had been declining for a long time, heart, kidneys, and brain more or less in sync, and while at the end the turn for the worse seemed sudden, I think it was really just the result of a long slow descent, like an airplane landing (safely) in the fog.

I have the impression that stoicism is having a moment, appropriate for confusing and difficult times, and coincidentally Dad was the paramount example of stoicism among all the people I've ever known. He was famously self-contained. He grew up poor on tenant farms during the Depression, the family abandoned by his father at an early age, finding an escape route by working as a stable hand for posh families on the Main Line.

In spite of circumstances, and his legendary unwillingness to speak, he managed to become Class President and Salutatorian of his high school class (1945). According to legend, he enlisted in the Navy to avoid having to give a speech at graduation. As it happened, the war ended while he was still in training at Pearl Harbor, so he did a brief stint in postwar Manchuria, then a few months in Japan. He was discharged in 1946, but still owed Uncle Sam the best part of a year, and was called up for service in Korea in 1951. There he was attached to a logistics unit, set up to distribute pay to soldiers and sailors invading the North--which service was abruptly interrupted when the Chinese army routed the UN troops and the entire enterprise was abandoned in a mad scramble for the ships. When his term of service was over, he was offered a chance to take Navy pilot training, but was not enamored of the prospect of landing planes on ships, and decided to come back home instead. Not long after, he met and married my mother (BTW, the second most stoic person I know). They were married for 64 years.

His love for and ability with horses was something I didn't really know about until Karen and I were old enough to be introduced to riding lessons when I was 10 or so. I was a sad disappointment to him, lacking both ability and confidence, but Karen took to it. It was only a few years later we moved to a small farm with pastures and surrounding open country, and horses re-entered his life in a major way.

From that point on, I watched the most interesting developments in his life from a distance, although he had considerable (I won't say endless) patience for my insistence on fishing, tennis, ping-pong, horseshoes, and other recreations more compelling to me. Until age became a major factor, he was consistently better at all that stuff than I was, and my adolescent frustration fueled some pretty serious, seriously one-dimensional, competition. It might be that the whole drama was contained within me--an outside observer might have had trouble finding any drama--but I thought it was real at the time.

Dad's competence (and his confidence) was such that he rarely hesitated to quit a job when he had had enough. Mostly he had a new job within a few weeks, and he generally he seemed to feel better off for having made the change. Not always, however: he did a stint as "Mr. Goodwrench" at a local Chevy dealer, and hated the association with a lame but well-known advertising campaign. He quit that job too.

I think his glory days came in the decade or so after he retired (maybe a trifle early, truth to tell). He became a full-time horseman. Between fox hunts, horse shows, and the daily cycle of feeding/watering/grooming/exercising/mucking out, he was fully engaged and extremely good at his work. This was a job he didn't want to quit, and he didn't. He was still working at horses last year, in spite of age, infirmity, and people finding him an easy mark. If that could have been sustained, I think he might have lived forever.