I haven’t read the literature on this myself, but my oncologist tells me the data are strong that taking walks—or just getting up and about—has a significant impact on recovery, especially regarding fatigue.  So, as I’m feeling so much better (being able to eat tends to do that), my partner Greg and I decided to take a walk today.  We just got back.

Now, going out is no small thing.  We have to select a very open place, with few people, not a lot of dirt or dust in the air, and not much wind.  I have to wear a mask and gloves to prevent acquiring an infection.   Sunblock is required on all exposed skin, so as to avoid stimulating my immune system, which might risk Graft Versus Host Disease (more on that later).  For the same reason I have to wear long pants, a long sleeved shirt, and, because I’m bald, a hat.  So, days ago, my handsome, sweet, loving Greg—who, bless his heart, knows nothing about baseball—went to the store and bought me sunblock and a hat . . . a New York Yankees cap.   And we’re living in . . . ahem . . . Boston.

So, we happen to be living across the street from Church Park, the so-called “mother ship” of the Christian Scientists—who, you know, dismiss medicine in favor of laying on of hands, prayer, and dead children. (Don’t get me started.)  Anyway, we walked around their reflecting pool, and by the time we got to the other side, my feet were starting to hurt pretty bad from the neuropathy—which has been much better, but walking really brings it out.  So we headed home.  No one had commented on my hat, and I thought we were going to slide into home plate, safe.  Alas, steps from our door, a group of snarky young men, seeing my hat, said, “He’s wearing that mask so he won’t get contaminated by the Red Sox.  Boo Yankees!”

I just want to point out that I despise the Yankees, and this is not my fault.

I study wasps.  That’s what I do.

Solitary wasps, like most animals, live their life . . . well, in solitude.  Except to mate, they tend to stay away from other members of their own species.  Some build small nests for their young, and some provide a modicum of parental care—the first steps toward social habit—but they do not live together in groups.

Social wasp colonies come in a variety of flavors.  Some are composed of tentatively co-existing individuals, and little cooperation happens, except to share a nest.  Some social wasps join together to make a group, and they fight to see who gets to be the queen.  The one that wins gets to lay eggs, subjugates the others, and the others often try relentlessly to overthrow her rule; they want to lay eggs too, and they have the ovaries to do so, but they often just settle for being a worker, a forager, a builder—and if they lay an egg or two, it’s surreptitiously.  I think it’s easy to see that this is a rather unstable social group, and even in these groups there are cycles of social behavior interrupted with solitary behavior.  Both social and solitary interests are obvious.

Other social wasps are more interconnected.  Some wasps in Central and South America (including Apoica) form large colonies of individuals who cooperate extremely well.  In this derived situation, the worker wasps are much more numerous, and they now run the show—they subjugate the queens, often kicking potential or undesirable queens out of the nest.  And the workers are workers, forever.  They can’t lay eggs. (They just don’t have developed ovaries; there are exceptions of course, but in general, they don’t.)  Only the queens have the properly developed organs needed to lay eggs.  Here, we see the first permanent and most fundamental subdivision of labor necessary for stable social habit:  The division of labor between the reproductives and the sterile workers.

The workers often come in different shapes and sizes;  the queen differs from them.  These differently equipped sterile workers work—they defend the nest; they forage for food, water and wood, which they macerate into pulp for the nest; they repair damage; they build new parts; they feed the young; and they dispose of the dead.   The queen does none of these.  Well, in some instances she may initiate the paper cells into which she lays the eggs, but other than that, she lays eggs and does little more.

None of these wasps are ever alone; when the colony gets too big, a group of queens and a group of workers, and rarely a small cohort of males (the workers are all female) fly to a new site and begin a new nest.  The solitary life has been completely abandoned; the division of labor has made sure of that. These wasps are almost certainly locked, or approaching being locked, into sociality. The queen doesn’t forage and the workers all work.  They have specialized so much that reversal to the solitary habit would be difficult . . . but it does happen.

Rogue wasps defy the structure and reverse in their behavior to the ancestral, the solitary.  They eat food, take resources, enjoy protection, and contribute nothing. Sometimes they are outright aggressive (recall, solitary wasps don’t like to be around others).  They lay eggs (against the rules), and their offspring may inherit their tendencies.  They are commonly called “cheaters,” because they don’t keep the social compact.  They often lose in their mission that if unchecked could disrupt the entire social system.  They are ejected, or killed by other workers. But sometimes, their rogue efforts go unchecked, and the entire colony then can be at risk of collapse.  Because they shrug off their roll as worker (no doubt due to a random mutation), and reject the division of labor upon which the colony is based, the entire system can fail.

Other wasps have taken these divisions of labor even further.  In some hornets, for example, preliminary evidence suggests that the larvae of the nests, the young, are the only individuals who can digest food.  The adults feed the larvae, and the larvae feed back to the adults digested vomit and spit.  If the adults are separated from the larvae, they die of starvation.

This work, ongoing in my lab, is preliminary, as I said, but intriguing if true.  This would mean that the genes to digest food (which they all have) have been silenced in the adults, and only the workers express those genes and have those proteins and enzymes.  The larvae have become workers of a new and specialized type.  They have become the digesters of the colony.  They have become the stomach.  Division of labor has arrived at a new, extreme level: the development of tissues, organs.

So why am I writing about all of this?  Partly, of course, because this is the stuff I think about all the time: wasps, and the transition for solitary to social.  But I see clear connections to our bodies, and to cancer.  My view is not novel, to be sure, but for me it is comforting, in a way.

Each of us is a giant colony of intimately cooperating individual cells.  They all descend from a single cell.  At the first division, they could separate and go their own way, like bacteria do all the time.  But they don’t, at least not usually.  Sometimes this is exactly what happens.   A very good friend of mine was in the early stages of pregnancy years ago, before I knew her.  It isn’t clear exactly what happened, but something like this is plausible:  At some point during the early stages, an unfertilized egg, or the embryo’s cells, or some cell incurred a random mutation.  The mutation caused the cell to revert to its ancestral, primitive instincts.  That one cell shrugged off the social contract and started dividing without control. The cells would divide and go their own way, just like their ancestral bacterial brethren, with no cooperative instinct remaining.  In other words, one of the embryonic cells became a “cheater” in the social contract.  It didn’t play its roll, take its position as a worker, or as they are commonly called, a differentiated cell type. The cheater had the potential to destroy the entire colony, my friend.   In wasps, these mutants are called “cheaters.”   When it happens in us, we call it cancer.  (My friend has been cancer-free for years, thanks to chemotherapy.)

But usually, the cells all stay in line.  They don’t divide and go their own way; they divide, and stay, and differentiate into tissues—various subcastes of the worker caste.  Once we’re born, these cells do various things:  they defend the body; they distribute food; they repair damage; they build new parts; and they dispose with the dead.   The sex cells do none of these.  Sound familiar?

For my cancer, the correspondence is crystal clear.  In my case, the particular mutation that occurred was demonstrated genetically.  In my case two of my chromosomes in a single cell physically crossed over on another.  And when the crossing over occurred, the top part of one chromosome was attached to the bottom of the other, and vice versa.  This is a common enough occurrence, especially for germ, or sex cells (you know, our queen caste).  But in this case, when this happened, a particular gene, named bcl-2, was placed in contact with a so-called hyper-promoterenhancer^‡—a region of DNA that controls the expression, the copy rate, of a gene. Bcl-2 makes a protein, and placed next to this hyper-promoterenhancer, it started making a lot of this protein.

This particular protein—from an ancient gene that we share with nearly all cellular life—in multi-cellular organisms controls a phenomenon seen in their cells called apoptosis, programmed cell death.  Programmed cell death is a fundamental part of the social contract of our bodies, our apoikas of individual cells.  In such a group environment, cells can’t divide without end, and they can’t stay forever.  Cells must die sometimes, and make way for other cells, else the group of cells—our bodies—may have problems.

And here was the crux of my problem.  The more bcl-2 that is expressed, the more easily a cell can resist signals to kill itself. So in me, when bcl-2 started being hyper-expressed in that one cell, it became immortal.  And with that, the social contract was broken, and the cell started off on its own way, dividing and giving to all its daughter cells the same tendencies.  As this social cheater continued to pursue its selfish interest, the whole colony—my body—started having problems.  And I got sick, as those immortal daughters became so numerous that they began to clog up passageways, organs, and vessels.

This is the natural history of my cancer, follicular b-cell lymphoma, the best example that proves cancer cells are nothing more than cheater wasps at the nest.  From their perspective (that is, from a selection standpoint), being freed from programmed cell death ain’t a bad thing at all.  Individuals that leave more offspring win, right?  This cell was on Logan’s Run . . . and having lots of babies at the same time.  The problem is, all those cells that are (were?) in my body don’t have global knowledge, and so they don’t realize that they are sealing their own fate:  If the colony dies, so do they, in this case.  There is no complete reversal to the free-living single cell.  We’ve evolved too far for that.  Or have we . . . (more on that later).

This is my view.  I just wanted to share it.  I am comforted by it, because I understand the how and the why of my cancer.  I have never once asked “Why is God doing this to me?”  That’s just never been in my head.  I know why I have cancer, and I understand that the cancer cells in my body—once freed from the social contract—are just like bacterial invaders.  They are trying to make their way, and reproduce, like all other creatures.  It’s simply an unavoidable consequence of nature.

^‡UPDATE: The distinction between a promoter and an enhancer is subtle, and I won’t go into it here. But I needed to correct it, because in an attempt to write generally, what I wrote was technically incorrect.

A reader writes:

I have to tell you I disagree on your statement that “only plants are spiritually clean” on killing others to survive. Plants are as vicious as any other living organism. There are plants that release herbicides through their roots to kill or stun the competition. See examples that I found on the internet

http://www.sciencedaily.com/releases/2003/09/030909071258.htm;http://www.sciencedaily.com/releases/2007/10/071012084128.htm

and how about carnivorous plants! They are down right killers.

I would certainly not leave parasitic plants off the hook either – they may not shoot to kill, but they sure make their living out of other plants and even fungi.

There! That’s my 2 cents.

Agreed.  I spoke too generally.  I should’ve said, “some plants.”  And this just shows that the biological conflict I was discussing is even more pervasive than I described.  Life is indeed red, in tooth and claw . . . and root.

One of the drugs I’m on for immunosuppression makes me shake constantly.  It’s getting annoying. This side effect, coupled with the neuropathy in my hands, makes simple tasks, like lifting a fork, difficult.  I wonder if this is a glimpse into how people with Parkinson’s feel?  Probably nowhere nearly as bad, but it bites nonetheless.

The drug, tacrolimus, is not used widely for stem cell transplants, but is used generally for kidney transplants.  It’s strange that I’m struggling to rebuild my immune system, and I’m taking drugs to slow that process way down.  But this is part of the dance—coaxing the new cells to slowly, ever so slowly open their eyes, and think that what they see is self.  If they wake up too quickly, they’ll see clearly and attack.

A related immunosuppressive drug that I’m taking, sirolimus, is used probably by even fewer stem cell transplant centers, but the data on this drug are impressive.  As an inhibitor of the mammalian Target Of Rapamycin (mTOR; indeed, sirolimus is rapamycin), it blocks a complex cascade by which cells proliferate, and so all is slowed down.  The new cells are very sleepy.

I’m very lucky to have these drugs.  My current physician is rare in that he does clinical research, and he is actually good at it (this is rare among physicians).  These immunosuppressive drugs, coupled with other novel treatments, are the reason my hospital’s success with stem cell transplants is so much higher than the national average.  Every day I am grateful that I have the care I have (and my praising physicians is as rare as their conducting good research, so that should tell you how confident I am in my physician).

It is worth noting that both of these chemicals are natural derivatives of bacteria:  tacrolimus comes from one species of Streptomyces, sirolimus from another species of the same genus.  In fact, most of the chemotherapies I’ve had are naturally occurring biological products.  Vincristine—one of the first chemotherapies I ever took, and a potent inhibitor of cell division—comes from the Madagascar periwinkle, once placed in the genus Vinca, where the drug gets its name.  Adriamycin, a chemotherapy that damages DNA directly, is also derived from bacteria. And an experimental drug currently showing great promise, Gossypol, is an unaltered, direct extract of the cotton plant, found in the stems, roots and seeds.  This drug directly blocks bcl-2, the epicenter of my cancer’s existence, but more on that later.

I could go on and on.  Hundreds of our pharmaceuticals come directly from natural sources.   The only difference between so-called “natural” medicine and “western” medicine, again, is that the latter is subjected to careful testing, and the former is not.

I can’t believe I could type all that with this much shaking.

You’ll notice I’ve added that image to the blog, a link to The OUT Campaign, a site dedicated to encouraging atheists to come out about their views.  This is something that I’ve had a hard time doing for many years, despite overcoming many other fears years ago (for example, having been out as a gay man since I was sixteen).

The main reason it’s been hard for me to tell others about my atheism is that I have many friends and loved ones who are believers, and I cherish their company, respect their choices, and would hate to offend them.  I have not posted this image to offend anyone.

But for this blog, it makes sense.  Pervasive in our culture is the view that mystical forces—unseen and all-powerful, ancient and misunderstood—are the true solution to cancer.  As Sontag observed in her incredible work, Illness as Metaphor, this view is common to all diseases when the ultimate cause of the disease is unknown, or poorly understood.  For people with cancer, we often become desperate and despondent when therapies fail—I know these feelings all too well.   And so many turn their hope to magical, “eastern” therapies.  As far as I can tell, the only difference between the evil “western” medicine and the enlightened “eastern” “medicine” is that the former has, by definition, been subjected to empirical test, and the latter has not.

But people who hold these unscientific views are unrepentant: About a year ago, I was visiting some friends after yet another therapy had failed, and my cancer had doubled in volume; I was, I think understandably, disappointed, sad, and probably a bit grumpy.  And a person I had only met a day before told me that people who are happy are more likely to survive cancer than sad people.  When I asked for the name of the peer-reviewed journal from which this insight derives, she said she thought she read it in Omni Magazine (a discredited, discontinued, pseudo-scientific publication that promoted supernatural phenomena cloaked in the language of science). Her message here was clear:  It’s your fault that you’re loosing this battle; cheer up, or face the consequences.  (That fall, the fabulous Barbara Ehrenreich eviscerated this nonsensical view; you can find an excerpt here.) So I asked her if she thought it would help if I shoved a crystal up my ass.  She was not amused, and I think, remained unaware of the horrific statement she’d made.  Her husband (another atheist), standing next to me, hung his head in shame.

The view that crystals, and prayer, and laying on of hands can cure people of cancer is growing in our culture.  When last in the hospital, with my horrific C. difficile infection, a staff member came into my room one day and explained that she could perform Reiki on me, which would help my nausea.  My nausea was caused, as she put it, “of course, by unbalanced energy.”  Um, no: My nausea was caused by an infection, thank you very much.

And this is quite strange, given the growing success of modern medicine’s treatment of cancer. Just look at the death rates for breast cancer below.

From the American Cancer Society's "Statistics for 2009."

Death rates were essentially stable or rising prior to the early 90′s, when genetic techniques (and thus, intimate understanding) first became available.  Crystals and the like were being used just as much in the 70′s (probably more), but it was the science that made the impact, not the white light visualizations.  The biological research that informs physicians is imperfect, and many still die, but this does not mean we are failing.  Science is recursive, unlike any other system of knowledge; it challenges itself, by its nature, to prove existing ideas wrong.  Still, not all cancers show this pattern, but the science that biologists use to discover details of the natural world inform physicians, who employ this knowledge to save lives.  And many lives have been saved.

But this hasn’t stopped many people from thinking otherwise.  Stanley Tucci recently lost his wife to a form of cancer, and in a Fresh Air interview proclaimed that she did not die of cancer, but of the “conventional” treatments for cancer (the discussion of cancer begins at 18:35,  and Tucci’s comments on alternative therapies begin at 19:30).  Tucci went on to say that he only found out about “alternative” (that is, not subjected to empirical test) therapies months before his wife’s death, and concluded that had he known of these alternatives earlier, his wife would still be alive.  I love Tucci; in fact he is one of my favorite actors, and I’m sure he is horribly bereaved; but this is just irresponsible.

Similarly, Bill Maher—famous anti-vaccine and anti-medicine advocate—in April of 2008 blamed Senator Arlen Specter for having cancer, and for his cancer’s relapse. (I would link to the YouTube video where I watched this, but it has apparently been deleted by HBO, even though many other Real Time episode clips from the same month remain.  Hmm.)

I have watched Maher off and on for years. I agree with much of what he says, and I think he’s brave and smart.  But for some reason, when it comes to medicine, he has lost all rationality. Maybe it’s because he’s lived in California for so long.  Who knows?   Only in a world where infectious disease has—with a few notable exceptions—been completely obliterated by medical action that derives from basic biological science, would someone claim that the real problem is the vaccine, the solution.  And I could put many links to The Huffington Post (which I generally enjoy) with similarly inane assertions.  Maybe I’ll do so in a later entry (but you can see for yourself in their Living section on any given day).  And just look back 70 years, and consider the hundreds of thousands of children who died then of infections we now rarely see—infections we have conquered, and in some cases eradicated, with vaccines—and it is clear that Maher’s hyper-modern, myopic view is flatly false.

Microorganisms are living things, and they are merely trying to stay alive, just like us. It just so happens that they make their living by harming ours.  We are no different; we must kill life to live as well. Only the plants are spiritually clean on this one.  So, good nutrition will not save the world from this biological conflict; variation in resistance exists everywhere, and bacteria and viruses evolve, becoming more adept at overcoming our defenses.  Good nutrition alone will not prevent infection, and many will succumb without the enormous benefit of medicine.  It’s quite perplexing (and, increasingly infuriating) to watch Maher rant against religion as stupid in one breath, and in the next proclaim that good nutrition is the solution to illness, and therefore cancer therapies are bogus, and pregnant women should not get vaccines.

So I am not writing this with Maher’s intent.  I’m not here to defame religion.  I’m simply putting this link in my blog because it is honest, and it is a reminder of an important fact that both people with cancer and their loved ones need to remember:  Cancer is a material condition; it requires a material solution.

I’ve just started a new drug for the peripheral neuropathy.  The drug turns me into a complete zombie: I’m unable to stand, extremely sleepy, hallucinating, and unable to focus my eyes.  These symptoms are supposed to pass in a couple of days, but the central nervous system impact of this drug is much, much greater than any narcotics I’ve taken.  The good news is that the new drug does indeed completely eliminate the pain in my hands and feet, whereas the narcotics did not.

Neuropathy, abdominal pain, diarrhea, nausea, vomiting, narcotics, dehydration, extreme fatigue, and crushing sadness—these are the experiences I’ve been enjoying for the last week.

This has been a hard week—the last few days especially so.  With the ongoing C. difficile infection (which is perhaps fully suppressed now . . . maybe), I’ve been eating nothing but yogurt for more than a week.  Well, I did have a banana two days ago, but the point is I’ve been wiped out.  My protein levels have been low which caused my cells to start to lose their integrity, leaking fluid that was filling my feet like balloons.

I knew that the stem cell transplant would be hard, of course.  But I was naive; I did not anticipate the immense fatigue and my becoming nutritionally deprived.  I’ve never though twice about skipping a meal, or two, or even fasting for an entire day—I’ve done all of these many times.  But this transplant is fundamentally different.  My protein is low; many macro- and micronutrients are very low, such as magnesium and potassium, so I have to take supplements.  I should have anticipated how much energy my body would require to build all of the cells in my blood, a mass that I suspect may amount to two pounds of tissue or more.  I guess people told me I would be tired, but I thought they meant chemo-like tiredness, the kind that comes and then passes a few days after the infusions.  I didn’t get it that I would be completely wiped out for weeks, or months.

I’ve been exhausted most of the time, and unable eat because of the diarrhea, so I get more exhausted, etc.  The neuropathy in my feet and hands means that walking requires the mustering of will and enduring the sensation of walking on hot coals. Showering means filling the tub with cold water so the warm water from the shower doesn’t burn my feet.  I rarely get out of the house, so no sun, no cherry blossoms (which I love).  I’m such a social creature, always needing to chat with colleagues and meet with friends.  Without that, sadness sets in, and sleeping all day because of the exhaustion makes it worse.  I’ve been in a very deep hole for too long.  The last two days, I cried almost continuously.

My lovely partner gently encouraged me to reach out to others on the phone, and that really helped.

I have had cancer for many years (officially diagnosed two months shy of four years ago, but I had it for years before it was finally diagnosed).  So, I know that many people—most people—have no idea what to say to you when they find out or when they see you after you’ve been ill, or whenever. I get it:  No one knows how to react to cancer.  I certainly understand.  But for all the good intentions, it is hard not be be slack-jawed at the things some people say. A couple of days ago it was, “Congrats on your stem cell transplant.” I’ve heard this one a few times before. Congratulations?  Really?

Since the first day after diagnosis, this was the one procedure that I was hoping to avoid.  It is not at all guaranteed to work, and the risks are extreme.  The fact that it ever works at all is quite impressive.  Coaxing someone else’s immune system to play nice inside a completely different body?  I mean, talk about cellular altruism!  These new cells should rip my body to shreds, and they surely would were it not for years of careful research that has revealed which drugs keep the new immune system from doing just that.  Of course, this procedure often fails despite the research, and despite the drugs, and the new immune system does exactly what it normally should do: Identify my body’s cells as foreign and attack.  This is a serious risk, not to mention the very high risk of infections that lingers for at least a year, often longer.  For me, I just flat ran out of other options, and so the choice was undergo this very risky procedure or surely die of cancer.  So, the transplant, despite the data on survival, became the logical choice.  I’m fortunate that my hospital can boast a first-year survival rate of about 90%, but the national average is nowhere near that. People die all the time of stem cell transplants.

Maybe people don’t know this, but they surely know that this procedure is not an award.   I try be tolerant of these comments; I really do.  I know most of the time, people say these things to try to be comforting to me, and usually to try to comfort themselves as well—to give themselves a sense that this horrible disease isn’t so bad after all, so that they can shield themselves from their own fear of getting cancer.  These are all human responses and perfectly understandable, but this disease is horrible, and the treatment is a last resort, and something that I very much had hoped to avoid . . . and it very well may kill me.  That’s the truth, so I don’t think congratulations are in order.

The last couple of days have been rough, and I couldn’t post.  But now it seems like the Flagyl is finally suppressing the Clostridium difficile infection.  These bacteria—like so many other organisms—can shut down most of their metabolic activity when environmental conditions are unfavorable, and while in this state, they are essentially impervious to antibiotics.  These spore forms can stretch their legs and start cranking our their toxins again once the antibiotics are out of my system, so relapse is always an issue.  I’ll be cycling on and off the Flagyl for the next few months to deal with this likelihood . . . that, and eating lots of gram-positive, “friendly” bacteria in the form of tons of yogurt.

This reminds me of a very cool group of organisms, sometimes called water bears: the tardigrades. Tardigrades are the closest relatives of the arthropods, and they haven’t changed much in a long time (the 90 million year old fossil tardigrade shown below looks essentially like modern species).

Fossil tardigrade, from Grimaldi and Engel's spectacular book, Evolution of the Insects

Tardigrades can hunker down into a spore-like condition called cryptobiosis, and in this condition they can live for centuries (yes, centuries) with no food or water.  In this state, they can survive intense radiation and even the vacuum of space.  No doubt, this ability is one reason they haven’t changed much:  If you can survive all environmental changes as you are, there won’t be much evolution going on.  Killing these guys could be nearly impossible when they’re hunkered down. So, to put in another way, as bad as C. difficile might be, I’m just glad I don’t have a colony of tardigrades up my butt (thankfully, they don’t cause disease).

As I mention in the About page, this blog is not going to be a diary of pain and suffering. Nor will it be a record of hopeful triumph, courage, bravery, and . . . vomit (well, it probably will be about vomit from time to time. I certainly have been doing enough of that). Yes, sometimes I’ll write as though I’m making a diary entry: what happened to me today, or recounting a past event. I do want the blog to relate those experiences. But I’m also just putting down my thoughts about cancer—those shaped by my training as a biologist and as a person who has cancer. But now, a first of the diary-type entries.

Today was a rough day in a string of rough days.  Immediately after my transplant, I had a typical litany of fairly minor problems: bacteria in my skin causing folliculitis, fungus in my crotch causing me to want to scratch myself to death, no platelets, no red blood cells, and of course no white blood cells.  This is what happens when your bone marrow is destroyed so that another’s can take up root.  So, I wasn’t surprised, and it wasn’t that bad.  The first week I was pretty pleased with how easy it was.

Then came the fatigue.  And I mean fatigue.  As is usual, everyone at the hospital told me, “Oh, yeah, that’s very common” after I was blindsided by it.  But I shouldn’t have been so blindsided; remaking your entire supply of blood cells is pretty heavy lifting.  If I missed a single meal, I thought I would die.  I had no spare energy. Not a bit.  But once I got used to that, all was well.  My new stem cells engrafted very quickly and started making for me a shiny new population of blood cells.  My white blood cells came first, as they do, and my platelets shot up to within normal levels shortly thereafter.  I was feeling great.

Then about a two weeks ago came the change:  Excruciating bowel pain, leg pain, diarrhea, among others.  After a spike in fever, I was admitted to the hospital, and after a blizzard of tests, it was discovered that I had Clostridium difficile.  I had actually been tested for this bacterium the week before, but the results were negative then.

This germ normally lives in our guts, but with all the antibiotics I’d been eating, the bacteriological ecology of my intestines had been altered,  and a new force was on the rise.  I’ve been dealing with the trauma of that force since, and the drugs I’m on are working, but slowly. Those drugs also suppress my new blood cells, so many of my cell lines have fallen dangerously low again.   I’m still having problems with my blood chemistry, because of the diarrhea; I’m still in a lot of pain (though less); and I still can’t eat much, which means I’m tired most of the time.

My nurse told me today, “Endure, endure!”  She sounded like Whitman, and it gave me some strength.