Wednesday, January 30, 2019

My New Augusta National Quest - Post 2 - "Induction"

I'm fighting hard every day to get back here

Despite the density and its negative reputation, I have always found New Jersey to be a pleasant place to live. Granted, I don’t live in Jersey Shore country, nor near Bada Bing! Think about the benefits: living one hour from New York City and one hour from Philadelphia offers access to the best pastrami sandwiches and cheesesteaks in the world. From a golf standpoint, it’s also nice to be able to have a short drive to both Pine Valley and Merion and to be a couple of hours from the National Golf Links and Maidstone. I have been healthy my whole life and prior to my diagnosis never gave much thought to medical care. I consider myself lucky that I was treated at the University of Pennsylvania, a sophisticated teaching hospital.

They say you want to be treated by someone who specializes in whatever your particular affliction is. So, if you need have knee surgery you want to go to someone who only does knees, all day, every day. It turns out that Penn is one of the best hospitals in the world for treating my type of leukemia, called AML. They have a large team of doctors who do nothing but treat this insidious disease all day. After my initial 48-hour rapid response I started to receive care from an impressive group of doctors and nurses. The results of my bone marrow biopsy revealed that I had a particularly virulent strain of the disease known as an FLT-3 mutation. As the great Yankee Lou Gehrig said, I caught a bad break.

Leukemia isn’t hereditary and there is no good predictor for it. It just comes, literally, in the case of AML, out of the blue. The standard course of treatment for my mutation is three regimes of chemo followed by a bone marrow transplant. AML is the same form of leukemia that tragically took the life of Australian PGA golfer Jarrod Lyle at age 36. That brave soul first had the disease as a teenager and had it come back twice more, going through the standard course of chemo treatment and a transplant each time. That poor courageous man, may he rest in peace. How anyone could go through this ordeal three times defies imagination and would tax even the most optimistic of us.

You know the odds of survival aren’t great when the doctors and nurses hesitate or look away when you ask them what your life expectancy is with this disease.

It depends.

The worse thing in the world you can do is to Google any disease. You only read the horror stories and of high mortality rates. “The wife” has wisdom and implored me to ignore all of them. Medicine has advanced significantly in the last 10-15 years; the statistics can be misleading or not applicable, and there are new treatments and drugs coming onto the market all the time. Ignore it all the wise one said. Even if there is just a small percentage of survival, you truly must believe that you are among that group and you have to fight for your life every day.

My entire month of May was spent tethered to one or more IV machines. I was getting medication 24 hours a day 7 days a week. And for those who have been lucky enough not to endure an overnight stay in the hospital, count your blessings. Make it a life goal never to do so. Sleep is a luxury, as is normal food. Privacy and personal space don’t exist. It is an artificial, antiseptic bubble that is the anthesis of normal life, although I must say that commuting for so many years through the dungeon that is Penn Station in New York did prepare me somewhat for the ordeal. Between the pain, the chorus of machines beeping and the nurses taking your vital signs or administering medicine every four hours, it is an alternate reality to anything I have ever experienced. I am not complaining, to the contrary, I am exceedingly lucky to have had 24-hour medical care by experienced providers and these people are true heroes.

Between my golf quest and my occupation, I have lived in a bubble the last 25 years. I work in the finance world, and Goldman Sachs CEO Lloyd Blanfien infamously said in 2009 that he was doing “God’s work.” The thing is, a lot of people that work in finance believe that what they are doing is noble. “I help people save for retirement or for their kid’s education,” you will hear people say, or we “help raise capital for people to start companies and create jobs.”

It’s a righteous way to describe pushing paper around and using other people’s money. It’s hardly noble or “God’s work.” Nurses caring for cancer patients in the middle of the night is God’s work and far more saintly than working on Wall Street. I’m in a bubble no more. The attendant in the ambulance that took me to the hospital was lamenting how she had to work two jobs and recently had her car repossessed. When I asked the nurses why they worked the night shift the answer was almost universally because it paid more money. The Hopi Indians have a word that describes how we value caregivers: Koyaanisqatsi. 

It means life out of balance. How is it as a society that people who put their lives on the line for us, run into burning buildings, and nurture us back to health during our darkest hour aren’t the most prized and well paid? The military have a more succinct description of it: FUBAR. This prima donna now clearly sees that our societal values are backwards.

In any event, I didn’t have much time to think about golf or to dream about my future in May, as the disease overwhelmed me. I was equally overwhelmed by the avalanche of love, prayers, positive thoughts and encouragement from friends and family. Thank you.

Monday, January 21, 2019

My New Augusta National Quest - Post 1

#11 Amen Corner Augusta
Your author in happy and healthier days at Augusta National

I have a tradition on my website, which is to post a year in review summary each January. Well, I didn’t have much to write about last year since I only played one round of golf because it was a true annus horribilis, to coin a Latin phrase. There is no other way to describe my dreadful year. You may have noticed I haven’t posted since May 1st 2018, which is fitting. On May 2nd I was diagnosed with leukemia. My demise began when I was feeling generally tired and having cold sweats at night. I just chalked it up to too much work and travel, too much flying, and too many nights in hotels. “The wife” thought it might be Lyme disease, so scheduled me to have a blood test on the first of May.

It’s never a good sign when a doctor calls you, right? It’s impossible to get an appointment at most doctors and once you get an appointment you sit for extended periods of time in the waiting room while being forced to watch The View. Once you actually see the doctor the visit feels rushed and they mostly do administrative work while staring at their computer. Aside from Joe’s Stone Crab, what other business model do you know that survives while making people wait? Ok, airlines and railroads also, but you get the idea.

I was driving to work on May 2nd (Black Wednesday), and my primary care doctor calls first thing in the morning to tell me that the blood test he drew had a bad result. And that I had to go to the hospital immediately to have another blood test to make sure it was not a mistake. I asked what he thought the problem was and he said that my white blood cell count was sky high and it could be leukemia. I didn’t know what leukemia was and had to ask. It is cancer of the blood.

I drove to the emergency room in Princeton where they re-did a blood test and confirmed that my white blood cells were through the roof. A normal range is between 4 and 11. Mine was 90. Leukemia requires such a specialized treatment that I couldn’t be treated in a good-sized, respectable hospital in a university town. I had to transfer to a hospital that specialized in leukemia treatment. I told the ER doctor that I wanted to go home and get a change of clothes, get some toiletries and that I would have “the wife” drive me down to the Hospital at the University of Pennsylvania. Body language and expressions tell far more than the spoken word. He didn’t have to say a word, the look on his face told me my imminent heartbreaking fate.

When he did begin speaking he said that my white blood cell count was so high that I was at immediate risk of death by stroke or blood clot and that the only place I was going was into an ambulance after they began an oral dose of chemotherapy.

I must say that in the world of medicine I am naive. I thought when you get cancer they had to run a battery of tests, you could get a second opinion, you could think about which course of treatment you wanted to pursue and weigh your options. At a minimum, you could go home to get your favorite sweatshirt. It turns out there are two types of leukemia, chronic and acute. I had an acute version which essentially requires emergency intervention and treatment on the spot.

The next 48 hours were easily the worst of my life. Upon arrival at Penn I was greeted by a team of doctors and nurses and admitted to a specialized floor for patients with blood diseases. The veins in my arms endured more than twenty incursions by needles so that my caregivers could run a variety of tests and begin to give me more than a half dozen medications intravenously. You’re heard of death by a thousand cuts. My journey began with death by a thousand pricks. And that was the easy part. The real fun began with my first bone marrow biopsy. In order to properly diagnose the exact strand of the disease the doctors have to extract marrow from the bone in your lower back. Let’s call it an invasive procedure and one where there really is no good way to anesthetize the area.  The procedure takes about 15-20 minutes and you can actually feel the marrow being pulled out in about 20 seconds of pure terror.

My life as I knew it was over.

And the day had begun simply enough. I had woken up, had breakfast and coffee and had a full day of work planned. Now I was under intensive treatment for a dreadful disease and would be in the hospital for the next 30 days. And the worst was yet to come.

Anyhow, the purpose of this post is not to depress you or to seek sympathy. I find writing cathartic and hope it helps. As my normal readers know I have always been a big believer in fate and to switch my metaphors from Latin to Roman mythology, Fortuna had different plans for me than the ones I laid out. Readers had always asked me, what will you do now that you’ve played the top 100 courses in the world? I didn’t really have any meaningful golf related goals so I thought I would wait and see what happened.

Well, this debacle happened.

It has been almost nine months since that dreadful day in May and I now have some new goals I want to achieve. As far as goals go they are basic:

1. Survive cancer
2. Go to Augusta this April to watch the Masters in person one more time
3. Play golf again

For those that have the fortitude for it, I will chronicle my new quest through the blog.

God willing, more to come over the next 12 months on my trials and tribulations, chronicling my fight, with observations about modern medicine, fairness in life, opioids, and golf  . . .

I still have some significant hurdles to overcome but can’t wait to immerse myself in the greatest game once again.