Dear Friends and Family,
“Well, Nancy, what do you think?”
“I think . . .” Nancy scratched the pretty pink hat covering her now fuzzy head, “. . . that I’m ready for a drink.”
Nancy’s full-throated laugh was bursting with mischief. It was not the laugh of someone in pain. And it wasn’t the laugh of someone burdened by the specter of a terrible disease. Rather, it was a laugh brimming with joy and genuinely from the heart. It was the same laugh I first heard twenty-eight years ago on our very first date.
As I shared with you many letters ago, during the first few hours of my very first date with Nancy, we discussed religion, death, kids, and the meaning of life. But I must admit, after three hours of nonstop talking as we watched the sun slowly fade and dip behind the Absaroka Mountains that lined the horizon in the northern portion of Yellowstone National Park—we got thirsty. So we somewhat nervously headed to the Two Bit Saloon in Gardner, Montana, for a drink,
(There’s something to be said about the “circle of life.” In many ways it seems like we have come full circle. Today’s laugh sounded just like our first time together. I loved that laugh then. And I still do now.)
Tonight, as we laughed together so many years later, we made our way to Joey’s, an upscale bar and restaurant surrounded by a marina on the shore of Lake Union in Seattle, Washington. Outside the full-length tableside window were row after row of sailboats bobbing up and down like corks in the never-ending waves. Beyond the boats were seaplanes taking off and landing at regular five-minute intervals. And beyond the seaplanes was an endless horizon where the lake merged with the sky. It was a romantic spot, and I felt like a young lover as I gently held Nancy’s hand and got lost in eyes that were even a deeper blue than the sky outside the restaurant’s large bay window.
Joey’s sits across the street from the Fred Hutchinson Cancer Center, next to our hotel. Today we obtained a second opinion from Dr. Fred Appelbaum, during more than an hour and a half of deliberations at the “Fred Hutch.” A world-renowned expert in both transplantation and acute myeloid leukemia (AML), Dr. Appelbaum had been both scholarly and engaging. He told us ever so kindly, “I can easily picture my wife and me on your side of the table.”
At the conclusion of our session, Nancy needed an escape from numbers and studies, treatments and side effects, and deliberations and decisions about her future. So I forced thoughts of Dr. Appelbaum out of my mind as I asked Sally, our waitress, “What would you suggest? This is a very special occasion for us.”
“Our house specialty is a drink called a Bellini,” she replied. “It is named after Giovanni Bellini, a famous painter during the Italian Renaissance. He created it in Italy in the 1930s.” She pointed to a picture of the drink on the menu: “It is a frozen blend of sangria, rum, champagne, and peaches. It comes by the pitcher.”
“I can’t say that I’m familiar with the painter, but the drink sounds incredible,” I replied. “We’ll take a pitcher.”
Our Bellinis arrived almost too picturesque to drink, a tall, elegant carafe displaying layers of red-and-orange swirls, with peaches floating on top as highlights. Sally gave the contents a hard stir and the colored layers suddenly transformed into a bright-purple slurry. She poured the almost luminous mixture into extra-large martini glasses and added a garnish of fresh pineapple, cherries, and limes. The drink’s taste was matched only by the drink’s beauty, and the pitcher was nearly empty before we began talking about our trip’s “opportunities.”
Nancy informed me she had made her first decision.
“Exciting news, Winnie. I feel really good and really strong today. Let’s accept Edgar and Polly’s offer and spend the next two days in Seattle.”
Quite simply, we reveled in the possibilities of the next two days together.
The Space Needle.
Bainbridge Island.
Pike Place Market.
The many options were quickly listed on the back of a Joey’s napkin next to an artist’s rendering of Mr. “Bellini.” We talked about fresh seafood for dinner and walks along the lake. A little overwhelmed, Nancy abruptly changed course: “I might just want to lie in bed and do nothing except watch sunsets.”
“Whatever you want, my love. We’re on our second honeymoon, aren’t we?”
Indeed, our evening was reminiscent of the first night following our wedding when we spent an entire evening on a beach in Tahiti, toasting our marriage with a blend of juices and alcohol served in a single coconut with two straws.
Nancy and I clinked glasses to each potential activity and without expressing it, we also toasted our relief. The meeting that would shape our future together was finally behind us.
Nancy poured the last few Bellini ounces into my near-empty glass. I convinced her to put her straw in my glass and share the remaining “nectar from the gods.” Effortlessly, with no change in her jovial presence, she took my hands so that all four of our hands rested next to the empty pitcher. “All right, Winnie. Let’s figure this out. What do you think?”
I wanted to say, “Let’s have another pitcher first.” Instead, I replied softly, “Nancy, I will help analyze the information that we’ve been given and make lists of pros and cons. I’ll do anything for you. But you’re the decision maker for our treatment options.”
“I know I am.”
“So let’s start with the transplant question.”
“Dr. Appelbaum was really good, wasn’t he?”
“Do you have any doubts about that choice?”
Dr. Appelbaum had been better than good. For almost two months, we have been trying to decide if a transplant was the superior route rather than undergoing two more rounds of chemotherapy. Every physician we polled used different numbers from different studies. Today, Dr. Appelbaum explained each of those studies, drew graphs on his whiteboard, and then individualized the data to Nancy.
He had started our meeting by saying, “The survival rate in Nancy’s case with chemotherapy is only 25%, maybe as high as 27%. With a bone marrow transplant her survival chance jumps to 63%, though some of the survivors, maybe 10%, have quality of life issues due to graft-versus-host disease.” Dr. Appelbaum went on to explain where the earlier 10–15% and 40% numbers had originated, and why neither applied to Nancy. His calm manner, confident deportment, and precise understanding of the known facts made the decision very clear.
“Nancy, I have no doubts. Transplant. Are you ready for it?”
“I am. I don’t want to go through another round of chemotherapy waiting for the donor. What if the donor is in Iraq?”
“Then I’ll fly to Baghdad. If he’s on the space station, I’ll go to the moon for you. It will be really hard to do another round of chemotherapy now that you’ve made the decision. I’ll call Rachael at 8 a.m. tomorrow so we can move forward as quickly as possible.”
“What about the type, Winnie? I really do need your help on that decision.”
I needed help, too. Dr. Appelbaum favored Nancy having a “mini,” but he had admitted during our meeting that the final data on that type of transplant was still a few years away. He felt confident the study he himself was conducting would conclude that the “mini” was just as effective as a “full” transplant but with less mortality and fewer side effects. But there were still a lot of unanswered questions.
Would his numbers change as the study progressed?
Would new or different side effects to the “mini” be discovered?
How should we decide between “experimental” versus “standard” therapies?
“I don’t have a strong opinion yet, do you Nancy? I want to speak to Finn Bo on that one.”
(Dr. Finn Bo Peterson, head of the transplant team at the University of Utah, has been leaning toward the full, myeloablative type of surgery. However, he freely admits the “full” transplant is more intense and much harder on the body.)
“Let’s defer that one for now. Both Dr. Peterson and Dr. Appelbaum said we have plenty of time before we have to make that decision.”
“Moving on, Winnie, I was really impressed with Dr. Appelbaum. Do you think we should do the transplant up here?”
I couldn’t help but think to myself is this “southern speak?” Is Nancy really letting me know she wants her transplant in Seattle?
“There is no doubt moving to Seattle will present some logistical challenges. But I will figure out every detail if you want to come up here.”
“But what about Jaret and Jayna? How would that work?”
“I don’t know. But what I do know is that they want whatever is best for you.”
Nancy sighed, and I noticed the first signs of melancholy. Her shoulders hunched forward a little and her eyes were not quite as wide as they had been earlier in the evening. “I want to make all of our decisions right now, Winnie. I’m tired of agonizing. But I guess we need to talk to Finn Bo first. I guess a couple more days is not the end of the world.”
“No, it isn’t. We’re almost there. Let’s go back to the room, rest a bit, and have an amazing dinner. As of right now, we’re officially on a real vacation.”
With only our water glasses, we toasted each other and to what lies ahead of us.
Summary: Our meeting with Dr. Fred Appelbaum, a world-renowned expert, was very productive and led to our first major decision. Nancy will proceed with a transplant. To celebrate our decision, we will stay a few days in Seattle to enjoy ourselves.
Much love,
Winnie