FINAL THOUGHTS (AKA THE POST THAT WILL GET ME TO ONE MORE POST THAN LAST YEAR)

MOVEMBER!

THE BARCA ALUSPORT FUTSAL MATCH WE SAW IN BARCELONA

HAPPY NEW YEAR!

THANK YOU 2013

I am thankful for many things this year.

My health continues to be good despite a few soccer injuries and the aches and pains of aging.

I have an amazing family with a great, supportive wife, two amazing kids, and a loving mom and dad and brother and sister.

Although I do not see my out of town friends as often as I would like, we remain close. When we do see each other, it is as though no time has passed since we last met. The connection, the understanding is still there. I have also made some great new friends this year - mostly through soccer and futsal. What is better than playing one's favorite game with great people?

I am thankful for cable television. I watch "Homeland" and so many football matches. NBC Sports and their Premier League coverage has truly changed our TV watching habits.



Many a Saturday morning, Nicholas and I will arise at 5AM to watch the latest "game of the week." What a treat. Here is the year in review.

We had wonderful trips in 2013. We went to the East Coast for Spring Break and saw some wonderful friends in NYC, Philadelphia, Wilmington, and D.C. In the summer, we went to Black Butte twice and Mount Hood. This Fall, we went to Barcelona to celebrate my 40th birthday. The kids did great on that trip, and we are already planning a trip to England for some football tourism next year. We ended the year with a great trip to Seattle.

There is no better gift to one's kids or better way to spend one's money, in my opinion, than travel. Who knows where we will go next, but I promise you we will keep going!

Several of the large federal grants that I slaved over in 2012 were funded in 2013, and I am truly excited about our research directions. I have three great people in my lab, who are committed to making breakthroughs and working their butts off. Fingers crossed that we will be able to contribute to our goal of a world without cancer-related suffering.

A wise man once said, all of us will die one day, but how many of us truly live? I am reminded of that each week as I care for amazing men and their families with my incredible team of nurses and clinical research staff. I could not imagine doing any other job!

These are just a few of the things for which I am grateful. Let's hope that even better and bigger things await us in 2014!

TRADING UP

When I was going up, baseball trading cards were all the rage. I even collected a few myself. These cards continue to be quite popular in many parts of the country. However, in my house, Nicholas collects all together different cards - football cards.

For Christmas, he asked Santa for some new cards. However, his request came one week before Christmas. This did not leave Santa and the elves much time to make the cards, especially since Nicholas already owns quite a few collections.

Santa apparently was up for the challenge, and on Christmas morning Nicholas found an album and fifty packs of cards from the UEFA Champions League, the pre-eminent European club football competition. Already, he has two-thirds of the cards he needs, and he will be saving up his birthday and Christmas money so that he can order some more.

Nicholas' interest in collecting these cards is about far more than football. He love to learn about where the players are from. He loves to draw them. Most of all, he loves to learn new things. 

I am happy to encourage his habit. Plus, I get the duplicate cards for the Barca players!

ME AND MY SHADOW(S)

It seems as though I have grown a shadow whether it is light or dark out. That shadows name is Nicholas.

He is with me from the time I wake up. We get dressed together. Invariably, he asks that we talk about soccer. I wait for him before I go downstairs… that is if he has not already woken up before me and gone downstairs on his own to draw or work on the IPad.

We play games together. We go to my work together on weekends and sometimes get a root beer float together. We watch football together. We talk about football together… a lot.

Increasingly, I am growing a littler shadow named Cate. She greats me in the morning. She asks for "just one more hug" before I leave for work. She even lets me give her little smooches sometime though she immediately and reflexively wipes her cheek afterwards. She always demands that we play on the same team when we go to the pitch too play football as a family.

Two amazing kids whom I love immensely and whose love for me I cherish. The image of those two shadows illuminated is what I will remember most about 2014.

THANKFUL

Today, I asked Nicholas to write down the reasons he is thankful. Here is his response.

I could not agree more. I am thankful for all those things, too, and I am thankful for Mr. Nicholas. 

Happy holidays!

KIDS SAY THE DARNDEST THINGS

This post is not about the late Art Linkletter (yes, I know I am dating myself). It is about a few recent phrases courtesy of Cate and Nicholas.

Cate uttered the following,"I don't have the faintest idea what you are talking about!" while Kathleen was reading her a particularly confusing story.

Nicholas seems to repeat "I am allergic to secrets!" every time we discuss the concept of Christmas.

There are far too many more phrases to share. Suffice it to say, these kids are truly exceptional in every way, including their diction!

WORDS MATTER

One of my favorite patients recently went on hospice. I have written about him and his wife before, but nothing could have prepared me for how quickly his cancer became out of control.

D and his wife recently set up a website to share his final journey with his family and friends. They graciously invited me to join, and I have read the entries by his wife and friends in the past few weeks. I was not sure whether I should write something, but I felt compelled last night to do so after reflecting on what D has meant to me. Here is an excerpt from that post:

I have been D's oncologist for the past three and one-half years, and it has truly been a privilege to get to know him, his wife P, and their family. While I have not met you all, I have heard countless stories about the love and devotion you have for D and that he has for you. I know that your support means the world to him. 

One is taught in medical school to remain objective and to erect a wall between one's self and one's patients. Oncology training is no different, and there are many days when people ask me, "How did you end up in this profession?" I used to tell them that I wanted to do something epic - you know, life, death, hope, fear. However, increasingly, I tell people that I am drawn to this field because of intense, yet wonderful connections with truly remarkable patients and families. This is a profession that can change you - for the better or the worse. But P and D have given me more than I could ever repay. They remind me of the importance of love, of loyalty, and of family and friends. 

Life is until further notice. Indeed, from the day one is born, life is a terminal condition. The knowledge of this fact is enough to make many lose hope. All of us will die, but how many of us truly live? Unlike you all, I only got to know Dan these last few years. However, what I have seen of D's life in that time is enough to fill a lifetime.  

I am a better person because I have known D. I would trade "objectivity" or "distance" any day for  the deep affection I have for him even though that affection will one day be accompanied by great sadness.  

I will miss D when he leaves us. However, when that time comes, I will raise a glass of Jameson (or 25 year Macallan - forgive me but the Scottish do make better whiskey than the Irish) and take comfort with the fact that D's life has been an extraordinary one and that I have had the privilege to be a part of it. 

More than anything, I wrote that entry because I wanted D to know before he left this life how much he meant to me. Words can be cheap, but words can also matter and come too late. I hope D sees my ode to him, and I hope it brings him some measure of comfort to know that he is more than the sum of his cells. D's actions, his grace, and his courage will not soon be forgotten by me or any of those whose lives he touched.

HOMELAND

Every now and then a show comes along that pulls you in, that has you "binge-watching," and that leaves you feeling empty during the hiatus between seasons. For me, Homeland is the best television show I have ever watched.

There are a number of reasons that I find the show so compelling. First and foremost, the characters are exceptional. The protagonists are Carrie Bradshaw, a CIA agent played by the lovely Claire Danes, and Nicholas Brody, a former POW from the Iraq war who might just be a terrorist played by the British actor Damien Lewis. These two characters would be wonderful without the other, but their on-screen complexity rises to another level when the viewer sees their intertwined story lines and their chemistry.

Second, Homeland is a show for our age. Terrorism, secret wire-taps, and intrigue are all part of the life we live, or at least read about, in 2013. Indeed, Homeland's depictions of life amidst the "war on terror" feel almost pornographic. The action is past-paced with intrigue around every corner. The viewer is always kept guessing, and there are more than a few plot twists... during each episode.

Yesterday, was the finale of Season three. I will not spoil it for you. I will, however, encourage you to rent Season one from Netflix or iTunes. It will probably take you all of one week to watch the entire season. That is exactly how long it took me! Season two builds to a dramatic crescendo, and Season three lulls one to sleep… that is until the last few episodes when the show delivers startling punch after punch.

Homeland is a revelation. It is an escape from our daily lives into the lives of these characters' who are our contemporaries in this age. Watch at your own risk! You will not be disappointed, but you will become addicted.

Only nine more months until Season four...

HALLELUJAH

Yesterday, we joined several other families from Nicholas' school at a Holiday Gospel concert downtown. Coleen Carey, one of the Arbor mom's was singing in the predominantly black gospel choir  that was accompanied by the Oregon Symphony.

Traditional holiday carols were re-worked, and the place was lifted with sweet, soulful singing. Most concerts at this hall are quite staid. However, this one brought the crowd to its feet, brought hands to together clapping in unison, and brought feet stamping on the floor. It was a celebration of God, Jesus, and religion. It was also a celebration of life and all the reasons we have to be grateful.

During that concert, I smiled over and over again. I thanked my lucky stars for my friends and family. I rejoiced about all that I have lived and about all the life that is yet to come. In short, his non-believer did a little Hallelujah inside.

Happy holidays, and here's to rejoicing over the little blessings that are far to easy to overlook everyday!

I will send you out with Jeff Buckley, who probably sang the most beautiful "Hallelujah" you will ever hear.

MONSTER MASH

Nicholas has been playing futsal on an Arbor futsal team this Winter. There are actually two Arbor teams in the same league. Nicholas' team is the the Red Monsters, and the other team is the Blue Monsters. I am not sure from where the names come. Perhaps one of the parents is a Gaga fan? Nonetheless, it is a truly great collection of young men, including some fantastic players.

The teams, in true Arbor fashion, are each coached by an older sibling of one of the boys on the team. I have had the privilege of serving as Assistant Coach of Nicholas' team, and it has been a blast to watch these boys play together. 

This weekend, we had the first of two meetings between the two Arbor teams. Affectionately, this match was nicknamed "The Monster Mash," and it was one for the ages.

Red quickly went up 1-0. However, Blue responded with three unanswered goals before half-time to take the score to 3-1. At halftime, I talked to the boys about playing with greater defense intensity and about following up shots in case there were rebounds. I also congratulated our goalie for playing an exceptional first half, in which he turned away over ten shots.

The Red Monsters must have heard me, or else they realized what was at stake in this match - bragging rights. They came out blazing and quickly tied up the game. With no more than three minutes to spare, Nicholas put in the game winner - a shot off of a rebound that he sent high into the net beyond his friend's grasp. Nicholas' teammates surrounded him and hugged him and gave him high-fives. Our bench also went wild, and I might have jumped up and down and screamed. You will have to check the tape.

Red scored another insurance goal, securing the victory in Monster Mash 1.0. The rematch takes place in 2 weeks!

Before this season, Nicholas had been the star of his local under nine years "U9" neighborhood team. He had the opportunity to play futsal with that same group of boys. However, he said he wanted to play on the Arbor team with his friends even though it was a U10 team and even though he would be one of the weaker players. He said, "Dad, I just want to be with my friends. We look out for each other, and we really like to be together."

So true. Sports should be fun, and it is always funner - win or lose - to play with one's friends. 

I  signed the Arbor boys up for another season after this one concludes. I hope to see many more goals. However, most of all, I hope to see many more moments of camaraderie and joy. Here's to all the little Arbor monsters!

GUILELESS

Nicholas Joshi Alumkal is truly one of the most remarkable people whom I have ever met. He is a third-grader mind you, but he is wise beyond his years and without pretense.

This morning was particularly challenging but was illustrative of Nicholas' wisdom and maturity. We have been preparing Cate's Arbor admission application, and this morning Cate expressed reservations about leaving her current Montessori school for Arbor next year. It was dramatic to say the least.

After she calmed down, I dropped Cate off at school, and Nicholas and I headed to Arbor.

I asked Nicholas why he thought Cate was so upset, and he said he thought she was afraid of the transition and the new challenges that Arbor would pose. He, himself, will be entering the third phase of Arbor next year, the Intermediate classroom of 4th and 5th graders.

Nicholas matter-of-factly said, "Dad, I would be lying if I said I am not scared about moving to Intermediates." He said that he was worried about the workload, which is rumored to be quite a bit more than 3rd grade, and he was concerned about many of the responsibilities that are unique to the Intermediate classroom. However, he said he knew that the school would look out for him and that many, many kids before him had done well in those grades. Later that day, Nicholas shared these feelings and thoughts with Cate, whom I hope was comforted by her brother's revelation.

There are very few things or people in life that are exactly what they appear to be. What one sees is what one gets with Nicholas. With Nicholas, one gets an exceptional boy indeed!

THE AUDACITY OF FATE

The week before last we travelled to Barcelona for a week-long holiday to celebrate my 40th birthday. Without a doubt, attending a Barca match was going to be the highlight of the trip. There was only one small problem. I was unable to find four tickets together for purchase through the club's website or through Ticketmaster. Therefore, I sought tickets through other avenues.

Our cancer institute has strong ties with Nike, who sponsor Barca, so I decided to try several channels to see if Nike could help us purchase tickets. To my amazement, Mr. Nelson Farris, a Nike executive here, contacted Mr. Marcos Garzo, a Nike executive in Spain who provided us four tickets gratis. 

Buoyed by that news, we flew to Barcelona on a Delta/KLM flight on Friday with a planned arrival on Saturday around 12:15 PM. The game had been scheduled to start at 9PM that same Saturday night, but it was moved up to a 4PM start. Needless to say, this made me quite nervous, and I even considered paying a fee so we could leave one day earlier in case their was a problem with our flight from Portland or our connection in Amsterdam. In the end, I decided to stick with our original flights. 

We arrived in Amsterdam with plenty of time to spare.  We lined up to board the KLM flight to Barcelona. However, the agent curtly told us we were at the wrong gate. It turned out that there was a different flight operated by Delta that just so happened to be departing for Barcelona at the exact same time... in a different terminal... where the gates were currently closing. Did I mention that that was the last flight that would get us to the game on time?

We sprinted to the other terminal and just barely made it on the plane prior to take-off. We landed in Barcelona on-time only to find that one of our bags did not make it. We finally left the airport one hour later and made it to our apartment at around 1:45 PM. Check-in was at 3 PM, but we were allowed to leave our bags in the apartment. Once we went up, Cate began to fell ill and complained that her stomach hurt. No doubt sleep deprivation and 16 hours of travel were contributory. Moments later, she was vomiting in the bathroom. She felt better afterwards, and so we decided to forge ahead and go to the game.

When we got into the taxi, Cate began to moan and complain about her stomach again. She was half asleep all the while, which made the scene even more troubling. I pictured the mess she might make in the back seat, and I struggled to remember the phrase for "I'm Sorry" in Spanish in case she threw up. 

Ultimately, Cate did not vomit, and we arrived safely. Cate pretty much passed out as we made our way into the stadium. However, she woke up right before game time one hour later. She was a new person after a bottle of Sprite and a hot dog!

We made our way to our seats, and we were dumbfounded when we finally found them. The seats were in the VIP section in the second row at the exact mid-field line right behind the players' bench. 

My jaw dropped, and we enjoyed watching the players warm-up and converse with each other. There was also a ceremony for Lionel Messi, Barca's forward and the best player on the planet. Messi was presented with the "Golden Shoe" award for the player who scored the most goals in a top European League, and he was literally ten feet away from us!

By the way, the game was incredible with Barca triumphing 4-0! A video is shown below from the club's website.

All in all, it was one of the best experiences of my life. Joy is the word that comes to mind to describe how I felt, particularly after all the challenges prior to the game. 

I am not one who believes in fate. However, there were far too many favorable turns of events leading up to the game.

Simply put, we were meant to be there. I am truly grateful to Messrs Farris and Garzo, to Ms. Caitlin Wilson from our cancer institute, and to all the stars that aligned to make that exceptional day a reality!

SMALL VICTORIES

It is often the little things in life that make all the difference in one's day. For me, getting on an empty elevator at work all by myself  brings an incredible sense of... pleasure. 

I realize that this says as much about me as a person as it does about the fact that my office is on the 14th floor of a 16th story building. That is all.

ENOUGH SAID

This weekend, Kathleen and I went to see the new film "Enough Said" starring Julia Louis-Dreyfus and the late James Gandolfini. It was one of the best movies I have seen this year and probably the best romantic comedy I have ever seen.

I put the word comedy in italics because this movie is deeply serious. It involves two middle-aged characters played by Louis-Dreyfus and Gandolfini who are both divorced and damaged in their own ways. Their insecurities and baggage are their greatest obstacles, and one cannot help but empathize with them.

I will not reveal too much, but I was simply blown away by how real and complex these characters were. They reminded me of all the self-erected barriers that stand in the way of happiness and how we are often our own worst enemy.

See "Enough Said" and experience this work of art for yourself. If you have ever been single or have kids, please bring Kleenex!

FORTUNE

This was my fortune tonight. Enough said.

WHY I COACH

This fall, I am the assistant coach on Nicholas' soccer team for the second season in a row. This is probably one of the most - for what word I am looking? - challenging things I have taken on. It is not for the reasons you might suspect - worry about favoritism of Nicholas, worry about being too critical of Nicholas. Rather, it is because many of these boys on our team act like five year-olds rather than eight or nine year-olds.

One of the top coaches in the world is Arsene Wenger, the manager of Arsenal Football Club in the English Premier League. He is famous for saying, "I am here to help players who are motivated. I am not here to help motivate players." The life of an under 9 (U9 for short) coach is a a far cry from Anfield Stadium in North London where Mr. Wenger plies his trade.

However, despite the disobedience and disrespect exhibited by some players, I have enjoyed watching every minute of Nicholas practice and play.

Yes, his footwork and ball handling have improved, and Nicholas routinely scores goals. More importantly, Nicholas is a leader on and off the field. He does not misbehave. He listens to advice from me and the head coach, and he tries to get his teammates back on task if they act up. There is a calmness about him, and he does not get frustrated despite several blow-out losses this year and fairly crummy conditions due to the Pacific Northwest fall weather.

Nicholas truly loves playing the game of football, and he has an encyclopedic knowledge of the contemporary teams and players. He spends hours drawing out scenes from games and writing down the squads for teams - both great and meek.

I hope Nicholas never changes, and I hope I have many more years of watching him play this game. At some point (perhaps soon), I will be sitting in the parents' section rather than the coaches section. However, I will always remember these two seasons with him up-close. I hope he will have fond memories of these seasons, too, one day.

Put simply, Nicholas is why I coach.

NEKO CASE LIVE!

Last week Kathleen and I went to see Neko play at Music Fest Northwest. We thought that Neko would be the second of three performers that night and had planned for an early Sunday night. However, it turned out that Neko was the closing act of the three. So, we suffered through the two opening acts and waited for two hours for Neko to finally come on.

It was a beautiful night and the concert venue - Pioneer Square in downtown Portland - was very picturesque.

Neko's performance was electric as usual, and it was certainly worth the price and the wait.

Here are a few outtakes. Enjoy!

THIS IS FORTY?

I could write about a lot of things tonight, especially since I have now officially spent forty years on this planet. I could write about each of these items shown on this hog's body from my futsal team's shirt, but I will spare you!

Indeed, when I thought about this post in recent weeks, I had very different ideas about what to write than I do tonight.

First, we will get the accounting out of the way.

I have been a parent for over twenty percent of my life - 8 years.

I have been a cancer researcher for over twenty-five percent of my life - 10 years.

I have been married to the same woman for over twenty-five percent of my life - 10 years.

I have been with said woman for over one-third of my life - 14 years.

I have been in medicine for nearly half of my life - 19 years.

Historically, I have thought of life as a continuous, mind and soul-numbing struggle for more years than I can count. Pico Iyer recently reminded us that there may be value in suffering, but try telling that to one who is suffering.

My adult world view can ultimately be distilled to a simple proposition - we have limited control over the outside world, but that does not mean we are powerless. Indeed, in a world devoid of God, we are responsible for everything we do. We are accountable to ourselves, to the ones we love, and the ones with whom we share this life. With this world view, a higher power becomes superfluous.

I came to see life this way through a variety of experiences - how others treated me (see high school and college years - you know who you are), through mistakes I, myself, made, and through the works of others - Camus, Kieslowski, Kundera, among others.

Thinking about this adult world view, reminds me of the perspective that my parents tried to instill in me as a child. I was trained to be thankful for what I had. I cannot count the number of times my mom said, "Look down and not up! Think of all the people who are less fortunate than you rather than those who are better off!" 

With all due respect to mom and dad, the past twenty years have been about constantly looking up. In college, I was motivated to get the best grades possible because that was necessary to get into a good medical school. 

In medical school, it was impossible not to stress out over grades, class-ranking, and standardized test scores because a great residency was at stake. 

In residency, I came to realize that I was quite good at doctoring. I went the extra mile not only because the patients deserved this and because that is the way I was raised. The opinion of my peers and my teachers was also at stake as was the spot of Chief Resident - an honor bestowed on the two top doctors out of each residency class at my institution. When I was named Chief Resident, additional opportunity and pressure followed. What top fellowship program would I apply to? 

During fellowship at arguably the nation's best hospital, I was surrounded by the best and brightest. It was hard not to look up at my peers who were more successful and more fluent in the language of research, especially since I was a beginner at science in such a competitive environment. 

Next came a faculty position and the pursuit of career development and advancement at my current institution. I recently completed my packet for promotion. For promotion, I wrote a three page letter describing why I thought I should become an Associate Professor. As I read the finished product, I found myself asking, "What was the opportunity cost of doing all the things I had done in the past six years to advance my career?" "What research opportunities had I missed out on due to administrative obligations?" "What family events  had I missed out on?" Two summer vacations my family took without me because of grant deadlines and countless seven day work weeks in the lab come immediately to mind. 

All of this is to say, that the past twenty years have been spent looking up - higher and higher and higher - almost to the point of vertigo.

Today, as I thought about writing this post later tonight, I considered how my experiences these past forty years have colored my vision and made me who I am. What struck me more than anything was how events in recent weeks have conspired or inspired me to write an altogether different account of my forty years than I would have written even one month ago. Indeed, these past few weeks seem more influential than nearly all the other weeks of my life combined. I think this ultimately comes down to a change in my perspective.

Recently, I have learned volumes from others' writings (e.g. George Saunders), others' songs (e.g. Neko Case), others' life stories (e.g. Emir Kamenica), and my own writing and my own experiences. I have learned that life is not not something to be suffered through. Life is a gift. Kindness is a lost treasure that can be shared and found. Beauty still exists on this earth. 

I am reminded by new and old friends alike (you know who you are!) and my family, especially my mom and dad and brother and sister, that I am fortunate to have people in my life who care about me and love me unconditionally. 

Despite the challenges of my marriage, I am fortunate to have a wonderful family and two loving, adorable children whose imagination and talents are equally matched by their potential to be forces of positive change in this world.

All of this brings me to to a revelation I had tonight on my way home. In the past two months, I have been riding my bike to work each day, which is a gift in itself. It is a peaceful ride that allows me to clear my head, get some exercise, and reflect on many things. Tonight, as I crossed the Willamette River I happened to look back - westward - at downtown. I saw the sunlight reflecting off the water and the buildings. I realized I was strong enough and well enough to ride 5.5 miles each way without difficulty due to my good health. I realized that I live in a place where it is safe to ride one's bike without fear of stray bullets or cars due to a caring populace and good urban planning. On this short commute, I saw my own life's journey of forty years in perspective. 

In short I took the time to look around, rather than looking up or down. What a novel concept! Indeed, appreciating what I have without regard to who has less or who has more, to quote Frost, has made all the difference.

I will leave you with the final number from Neko Case's show last night. 

I love Neko and this song, but I do not wish to be anything other than what I am tonight. 

May the next forty years be as sweet as the last forty year have actually been!

SHE'S BACK

This week, Neko Case released her new album, "The Worse Things Get, the Harder I Fight, the Harder I Fight, the More I Love You." While it has been four years since her last album "Middle Cyclone," this album was well worth the wait.

Her album is all the more refreshing because of the foolishness that currently monopolizes radio airtime [think Miley Cyrus, Robin Thicke, et al]. In stark contrast, Neko sings about the juxtaposition of despair and beauty that is ever-present in our world. She has the ability to capture moments in life that demonstrate the frailty but vibrancy of life like few artists, and that is what I love most about her songs.

No doubt her songs are colored by her own upbringing (or lack thereof) and recent battle with depression. Emotive is the word I would use to describe her songs more than any other, and the new album is no exception.

One song in particular completely blows me away. That song is called "Nearly Midnight, Honolulu," which Neko sings a cappella. I cannot do the song justice with my words, and I suggest you listen to it. Better yet, I suggest you buy the song and the album.

I am not sure yet whether "The Worse Things Get, the Harder I Fight, the Harder I Fight, the More I Love You" belongs in the class of "Middle Cyclone," one of the finest album of the past decade. However, Neko's new songs are quickly growing on me. Stay tuned!

It just so happens that Neko will be performing in Portland on Sunday, and I just snagged some tickets. Pics and musical memories to follow!

Good night and thank you Neko for reminding me of the beauty that is ever present in our world despite all our travails...

WHY I FIGHT

Today was Tuesday, which means I was in clinic. It was a hectic day because I had an overbook at noon, several patients were running late, and I was scheduled to speak to our Prostate Cancer Support Group at 5:30.

Nonetheless, I was reminded today why it is a privilege to be a doctor and an oncologist.

My first patient was an engineer in his early fifties. He had surgery but had concerning features suggesting that radiation could be useful. We talked not only about side effects but also about how he wanted to be around for a long time for his 11 year-old daughter. I told him that that was my hope, too, and that we had a good chance to control his cancer long-term. This visit reminded me that patients worry not so much about dying but about leaving love ones behind or leaving unfinished business. Life is until further notice.

The next patient was an emergency room physician whom I had seen as a second opinion on several occasions. His cancer was now back with a vengeance, and he was too weak for any more treatment. I was honest with him and said that I believed that more treatment would not help and that focusing on shrinking his symptoms with hospice rather than trying to shrink his cancer made more sense. I shared the Kleenex box with his wife on several occasions, and I explained that stopping treatment did not mean that his doctors would stop caring for him. If anything, hospice would allow his family members to go back to being family members rather than medical providers. With hospice, we would have our eyes, ears, and hands in his home. We hugged as they left my office for the last time. Baseball games in front of the TV with their grown son, with whom he had recently traveled to several stadiums, awaited as did quality time with his loving wife. I shared that if I were to become sick, Nicholas and I would surely try to see the great football teams of Europe in their stadiums. Cherish every moment.

Another long-time patient in his nineties came in. He had advanced prostate cancer that is responding to targeted therapy. He joked about wanting to make it to 100, and as usual asked for my cell phone in case of emergencies. Sorry. As usual, he asked about the kids and said he would bring them See's candy again next time. Life is like a box of chocolates sometimes.

One other patient was also particularly touching. He and his wife are lawyers and among my dearest patients and favorite people. He is in his sixties with a son in college, and I have treated him with several therapies, most recently chemotherapy. His clinical picture was a little confusing today, but all in all his disease looked stable. We talked about next steps and whether to take a break from chemo. He talked about closing his law practice and said he wanted to head to the East Coast for several weeks to see family. I endorsed this idea and said we could work treatment around his schedule. There was a pause, and then he and his wife asked the inevitable question, "How much time do I have left?"

I told them that I did not have a crystal ball and that if I did I would be playing the tables in Vegas. Knowing me for the past few years, they both replied, "You would not be caught dead in Vegas!" I chuckled and agreed with them. I said, "Worst case scenario is 6-9 months, and best case scenario is 12-15 months."

Like water rolling off a rock, these two brave souls took this news in stride, and we moved on to other matters. We exchanged hugs at the end of the visit, and I told them I would see them next time. I hate being wrong, but oh what I would give to be proven wrong about his prognosis.

Four brief visits. Four exceptional individuals. Four stirring vignettes. All true. Too true. So true that it hurts.

People often ask me why I went into Oncology. The short answer is that I wanted to do something epic, and there are few jobs more full of the big stuff - life, death, love, and longing. However, I have come to realize that I am not interested in these themes in the abstract or in characters from a novel or a play. I am interested in real people in the flesh and blood, and I am interested in helping them live as long as possible and as well as possible.

You might think that when I look at my patients, who are all older than me, I see my dad. Sometimes that is true. However, more often I see myself. I think about all the things I hope to achieve, all the places I hope to go, the grown-ups I would like to see my children become, and the life that I would be grateful to live to an old age.

Moreover, I do what I do because someday I know I will be on the other side of the exam room with a serious illness like cancer. When I think about that, I try to care for my patients as I hope someone might care for me. I know I am far from perfect, but my patients make me a better doctor and a better man.

I will leave you with a quote from the author Colum McCann from his wonderful novel and ode to New York City Let the Great World Spin that sums up why I fight. "The world spins. We stumble on. It is enough."

Tuesdays remind me that stumbling on is indeed more than enough...

QUOTABLE QUOTES

Catherine Reese is always one to entertain, but recently she has had quite a few verbal quips.

Here are but a few:

On hearing a loud argument- "What's all the hullabaloo?"

Contemplating wealth- "If I had money, I would spend it all on pizza and ice cream!"

What a cutie!

INJUSTICE

Yesterday, the jury announced that George Zimmerman was not guilty of killing Trayvon Martin. Martin was an unarmed, defenseless, Florida teenager whose only crime was being born black. 

The proceedings of the trial were closely followed, and many had hoped for a different outcome. No one made a stronger case for what was at stake in this trial than the New York Times columnist Charles Blow, who is a father of two young African-American sons. That is why, I first turned to Mr. Blow's twitter feed after the verdict was announced and why I looked for his column today. That column may be found here and includes a video essay by Mr. Blow.

I was so moved by this piece that I sent him an email tonight. That email is excerpted below.

Dear Mr. Blow,

I am writing to express my profound sadness about the verdict in the Zimmerman case. I am dumbfounded by the ruling, and I cannot understand the conclusions that these jurors reached.

As a brown man living in this country with a biracial son, I worry. I worry that this young man, who is pure innocence, will not be viewed that way by strangers because of his skin color. I worry that they will call him nigger like they called me when I was only a kindergartner. I worry that we have not come far enough in this country, and that a post-racial society will never come.

However, I also have hope. I hope because there are people like you who are a voice of reason and conscience. I hope because I have seen an outpouring of outrage, sadness, and compassion from all corners of the globe. I hope because the alternative - despair - is a pill that I am not ready to swallow.

Words - your words - always touch me, but never more than in defense of Trayvon and boys like him in every community. Thank you for all your efforts, for your words, and for giving voice to the concerns of so many who cannot be heard or will not be heard.

Best,

Joshi Alumkal
Portland, OR

What more is there to say?

TAKING STOCK

Life is busy, and it is easy to lose track of our own or other's growth or change. However, children are a great guidepost by which to measure progress because they go through such interesting and often fleeting stages.

This week, I took stock of two very special children - Cate and Nicholas.

Cate is now four and a half - make that four and three-quarters- years old and has had tremendous growth in the past year on all fronts. Cate can read books and is constantly sounding out words she sees written in magazines, prints on our walls, or even food packages. Cate can write her name and simple words by using phonics.

Cate continues to astound me and others in the coordination department. She was recently invited to join a "Premier" group of children in a soccer development program, and I have no doubt that she will become a great, multi-sport athlete.

Before I had Cate, I always said, "If I have a daughter, I hope she is a confident, poised woman like Mia Hamm" (who happens to be the world's best female soccer player of all time). Cate is on her way.

Most importantly, Cate's personality continues to take form, and I am constantly astounded by how much she and I have in common. Cate is a fierce critic of herself and is a perfectionist in everything she does. For example, the other day Cate knocked a magnet of the Barca stadium off the fridge by mistake. She knew that this was a special magnet that I bought in Spain, and she quickly ran upstairs to her room after she realized what she had done.

I followed her upstairs to comfort her. When I found her, she was visibly upset and kept repeating, "I am so clumsy." I quickly corrected her and told her that she was anything but clumsy and that accidents happen. After some distraction, I was able to help her move on.

While I appreciate the desire to do one's best, I have also witnessed firsthand the toll that perfectionism can take on one's self. I hope to help her become more comfortable with failing because life is littered with failures.

Nicholas is a creative and emotive young man, who also continues to astound me.  He is the most passionate child - make that person - whom I have ever met. His interests continue to evolve, and he looks within rather that to peers or the mainstream for his interests.

Currently, he is a scholar of all things soccer-related. This year, he did his Arbor independent project on the history of soccer, and it was, in my humble opinion, the best of the bunch of some very good projects.

Nicholas continues to love drawing and art.  Below is an amazing self-portrait that he drew at school.

Nicholas is also fascinated by the world at large and different countries and cultures. He may still have trouble pronouncing his "Rs," but he can pronounce multi-syllable, vowel-deficient Polish or other Eastern European names without difficulty.

One day, Nicholas found out that his babysitter had a great grandparent who was from Poland. He asked her if they could go on the internet to print out Polish words. That afternoon, he spent several hours writing out common Polish words and their English definitions. There are no Polish schools in Portland, but we hope to channel his energies into Spanish classes.

Nicholas' current goal is to become "a soccer player who eventually goes to play in Spain or somewhere else in Europe." Afterwards, he hopes to become an architect who builds soccer stadiums because, as he put it, "I love soccer, drawing, and building things. An architect seems like the best job."

Nicholas also continues to make strides in music. He began playing ukulele 3 years ago, and he is now playing mandolin.  He has surpassed me and Kathleen in competency, and he loves to perform. Recently, he and his teacher put on quite the show at Arbor for the whole school. I could not be prouder of the young man he has become.

I am always astounded when I step back and take the time to appreciate the growth of these kids. They are growing up so fast, and it makes me sad to think that they will leave one day or that I will no longer be here to see them keep growing and changing. Times like tonight remind me how lucky I am to be their dad.

After Manchester City won its first Premier League title in over 40 years last year in the last minute of the season, the great soccer commentator Martin Tyler exclaimed succinctly "I swear you'll never see anything like that again... Drink it in!" If I were drinking to celebrate Cate and Nicholas tonight, I would be a very proud and drunk dad...

BEFORE MIDNIGHT

Tonight, I went to see the new Richard Linklater movie “Before Midnight.” This is the third movie in a trilogy that began with “Before Sunrise” and then “Before Sunset.”  Each movie features the same characters – Jesse, an American man, and Celine, a French woman.

These characters meet for the first time in their 20s in “Before Sunrise” while each is on holiday. In that movie, Jesse somehow works up the nerve to strike up a conversation with Celine on a train. He convinces her to get off with him in Vienna and explore the city. A romantic night of talking and connecting follows. However, in the end, these characters go their separate ways.

Jesse eventually becomes a writer and writes a book about that night. In “Before Sunset,” Jesse is in Paris on a tour promoting that book. As you might have guessed, Celine shows up to the reading. At this time, the characters are in their 30s, and Jesse is unhappily married with a young son living in the U.S.  Jesse and Celine reconnect and enjoy another memorable day together. At the movie’s conclusion, we, the audience, are left wondering what will happen next for these two.

In “Before Midnight,” Jesse and Celine are in their 40s. They are now a couple that lives in Paris with their twin daughters, and they have settled into a domestic routine.  The movie takes place during their holiday in Greece, and much of the movie features the two of them conversing about their lives. A lot of deep-seated feelings and resentments bubble up to the surface, and their calm, whimsical discussions quickly become resentful. 

It is amidst the fighting, that we truly come to appreciate the humanity of these two characters. They are not two beautiful people with perfect lives and carefree existences. On the contrary, they are people who have deep misgivings about some of their choices, their partners’ behaviors, and their futures. 

In this sense, these characters embody so many people who are or have been in long-term relationships.  It is not easy to sustain a marriage… especially when one is busy with work, kids, and life and continually stressed-out. On top of that, we all change as we grow older. What was once desirable, acceptable, or tolerable no longer feels the same way. It is in these moments, when one begins to wonder, was it all worth out? The answer is complicated and most definitely very personal.

For most of our post-pubescent lives, we long for one thing – to be accepted and to be with someone else. Who can ever forget the worry of finding a date to the prom, having a girlfriend, or getting married? Our society constantly presents marriage and relationships as the norm, the ideal. Evolutionary theory also tells us that it is in our interest to pair up and reproduce so that we may leave a genetic legacy.

However, what if marriage and coupledom is not the panacea for which we had been hoping? What if living in a prolonged state with the same individual leaves one feeling diminished rather than aggrandized?  This is the theme Jesse and Celine tackle on the night in which “Before Midnight” takes place. Just like in real life, there are no simple answers or endings to their tale. The audience, or at least this audience member, is left wondering what will become of these two and also what should become of us?

Life does not always turn out the way it is supposed to. In many instances, that is no one’s fault. If anything is to be blamed, it is time. Time passes quickly, but change is continuous though often imperceptible. That is, until one steps back and realizes what has become of one’s life, one’s family, or one’s marriage.

Some - perhaps the ones that we often call wise - are able to appreciate the good with the bad. Others only see the darkness without the light. However, before midnight it is difficult to know which of these perspectives is wrong and which is right...