Tuesday, May 31, 2011

Paranormal Novels Continue to Sell.

There was an interesting article in Friday's Wall Street Journal (WSJ) which reports that the popularity of paranormal genre novels has not escaped the notice of the higher brow literary writers, now trying to cash in on this trend's success.
Following a string of supernatural successes, including last summer's hit "The Passage," a vampire epic by literary novelist Justin Cronin, and the recent surprise breakout "A Discovery of Witches" by Deborah Harkness, novelists from across the literary spectrum are delivering fantasy-tinged narratives.
The article opens with Glen Duncan, described as "a 45-year-old novelist who lives in South London," and whose latest novel, The Last Werewolf will be released on July 12. It turns out that Mr. Duncan "invented Jake [his protagonist, a werewolf] out of desperation. His previous seven literary novels sold poorly, and his agent said the prospects for selling the next one were bleak. 'It was a rather mercenary and practical decision to try to write a straight genre novel,' Mr. Duncan says."

The WSJ goes on to describe four more paranormal novels with literary aspirations. I've written about one of the authors before. On September 22, 2008 here, I described a YA novel by Melissa Marr titled Wicked Lovely which I recommended. Her first adult novel, Graveminder, was released two weeks ago in hardcover. I don't recall seeing it, but plan to go looking for it this week.

Go here to read the Wall Street Journal story which includes a video of the article's writer describing this literary trend.

And, by the way, another YA which I highly recommended here, The Hunger Games, has been optioned as a movie. The protagonist Katniss will be played by Jennifer Lawrence, who was nominated for an Oscar last year for Winter's Bone. Jennifer Lawrence was on the cover of Entertainment Weekly last week with dark braids dressed as Katniss. Filming on The Hunger Games began on May 19 in North Carolina. I've heard Donald Sutherland will play the president, Woody Harrelson will play Haymitch, Elizabeth Banks will play Effie and Stanley Tucci will play Caesar. The Hunger Games was the first in a trilogy which ended last August with the release of the third book, Mockingjay.

Saturday, May 28, 2011

The Emperor of All Maladies

As I explained earlier this week, I've been feeling overwhelmed and more than a little anxious lately.

Everyone has coping skills that help them manage the stresses of daily life. Psychologists rate coping skills along a continuum from pathological to mature. I have a variety of defense mechanisms that I fall back on in a Chinese menu kind of way: one from column A, one from column B and another from column C.

When I'm behaving maturely, I tend to use humor to help me manage while, at the same time, I suppress the uncomfortable thoughts and feelings. When the stress increases, I fall back on less mature mechanisms like intellectualization and magical thinking.

This month, I did not pass "go"; I went straight to those neurotic coping skills.

Since I was anxious about having to face yet another Mohs surgery for skin cancer, I fell back on my immature defense mechanisms. First, I upped my exercise routine from five nights a week to seven (thereby magically "undoing" the unhealthy situation by acting in a more healthy manner).

But because on the face (no pun intended) it was cancer that was frightening me, I intellectualized that a book would give me more information on the subject, theoretically increasing my sense of competence and control (while at the same time permitting me to suppress my fears related to my mother's steady deterioration).

Last November, I first heard about such a book during an interview on NPR's Fresh Air. Since that time, the book won the 2011 Pulitzer Prize for general non-fiction. The title is The Emperor of All Maladies: A Biography of Cancer, and the author is Dr. Siddhartha Mukherjee, an assistant professor of medicine at Columbia University.

I remembered the interview clearly and especially a segment in which Dr. Mukherjee was asked to describe what causes a cell to become cancerous. I went back to find that broadcast of Fresh Air, in which he said:
In cells, there are genes that are present whose normal function is to regulate the growth, the metabolism and the cell division of cells. And corruptions of these genes, mutations of these genes, essentially activate or inactivate critical processes that act like accelerators and brakes. So to rephrase this, you can imagine the cell as a molecular machine, and cell division is one of the activities it performs. And there are accelerators and brakes on cell division ...

By mutating genes, if you jam the accelerators or if you mess up the brakes, then the cell doesn't know how to stop dividing and it begins to divide incessantly. And part of that division also creates even more mutations. Sometimes there are genes that can be mutated which can accelerate the mutations of other genes, and this process goes on and on until you have a cell which is now capable of infinite cell division and does not know when to stop dividing. And that's what unleashes a cancer cell. But that said, I think that's just the beginning of an understanding ... there are many, many other features of cancer which are still in their infancy in terms of our understanding.
Two weeks into it, I'm a little more than halfway through the book, which is astonishing to me. I'm accustomed to reading most books--both novels and non-fiction--in a couple of days. However, my desire to understand this subject matter has me taking detours via the Internet to buttress my small store of high school science knowledge.

As an example, I remembered there were three kinds of cells (red, white and platelets), but couldn't for the life of me remember what platelets do (assist in the clotting of blood). And I absolutely did not remember where blood cells are manufactured (in the bone marrow). And I swear to God when I went through school, we were never taught that our immune systems have three major types of lymphocytes that fight infection: T cells (thymus), B cells (bone) and NK cells (natural killer).

Dr. Mukherjee is very thorough in his approach. He describes the history of the study of cancer from its earliest beginnings: a papyrus in which an Egyptian physician who lived around 2625 BC describes a case "having bulging masses on [the] breast that ... have spread over his breast." Under therapy, Imhotep says only "there is none."

The good doctor Mukherjee has a tendency to devolve into what I would describe as "purple prose" through his use of metaphors and similes. I laughed out loud at this sentence: "But Cole now wondered whether Halsted had tried to cleanse the Augean stables of cancer with all the right intentions, but with the wrong tools."

I am, however, struck by his humanity in recounting the story of cancer. He openly addresses the arrogance of physicians who refused to consider any theories of cancer which did not fit their own world views. In the early-1970s when an oncologist at the National Cancer Institute (NCI) proposed a treatment regimen of surgery followed by chemotherapy, no American surgeons or chemotherapists could be located who would agree to such a protocol. As the result of all that hubris, the NCI was forced to sponsor that first clinical trial at the Istituto Tumori in Milan, Italy where "Bonadonna and Veronesi, the only surgeon-chemotherapist pair seemingly on talking terms with each other" agreed to accept an award for the NCI trial. The results of that trial shook "the terra firma" of cancer research. The combined treatment "prevented breast cancer relapses in about one in every six treated women," a stunning victory at that time.

I also sensed Dr. Mukherjee's outrage was genuine when he talked about the medical profession's failure to focus on symptom relief and comfort of the patients who were dying under their care. "The movement to restore sanity and sanctity to the end-of-life care of cancer patients emerged, predictably, not from cure-obsessed America but from Europe."

It is staggering to me to realize how far cancer treatment has come over the last forty years. Just this week, I read a newspaper article about an experimental drug that has killed a "rare, stubborn form of cancer called acute promyelocytic leukemia ... Tamibarotene ... is a retinoid drug that induces [immature] cancer cells to differentiate into mature cells and eventually die."

Bottom line, I'm feeling more optimistic and want to recommend this book to anyone dealing with (or simply interested in) the subject of cancer.

Thursday, May 26, 2011

The Next Challenge

I said I'd talk about the couple of things that derailed me earlier this month.

The second thing that threw me off course started one morning while I was washing my face. My fingers brushed a rough spot on the left side of my nose. I picked up my magnifying mirror and squinted at the tiny area of skin. It was barely noticeable, but irregular in shape and scaly. "Oh-oh," I thought.

As I drove to work, I called my dermatologist's office to ask for an appointment. The scheduler said, "You're coming to see us in July. Can't this wait until then?"

"Nope," I said. "I want an appointment this week."

Begrudgingly, she gave me a time for the next morning.

My dermatologist took one look at the spot and called his nurse to assist in a biopsy.

A week later, the nurse called to say they'd be referring me to a surgeon for Mohs surgery. Since I practically have a surgeon on retainer these days, I had no trouble scheduling the surgery.

If you want to know what Mohs is, or what to look for when checking your skin, go here to read an earlier blog on the subject.

I've had multiple skin cancers (both basal and squamous) removed over the years. However, the time between them seems to be getting much shorter. I had a lesion removed in June, 2007 and another one excised sixteen months later in November, 2009. Now eighteen months later, I have a new basal cell cancer. I don't know if it was this lesion's prominent location on my face or the fact that this is the third Mohs surgery I'll have had in four years, but this one bushwhacked me. My anxiety climbed, and my mood tanked.

As usual when I'm feeling out of control, I went looking for a way to re-establish my equilibrium.

I found a solution. I'm pretty excited about it, and I'll tell you all about it on Saturday.

Tuesday, May 24, 2011

Let's Try This Again

Three weeks ago, I announced I was back and then promptly disappeared again. I figure I owe an explanation.

Two things knocked me off my stride. I'll talk about one today and the other on Thursday.

The first was the need to reorganize my mother's finances to permit her continued residence in an Alzheimer's facility.

Fifteen months ago, my family moved Mom from the home she'd lived in for nearly fifty years to a residential facility (pictured below) devoted to patients with memory loss.

At the time we made the move, my three brothers and I were at varying degrees of acceptance that such action was even necessary. We were deep in discussion (AKA argument) when the police removed Mom from her home and took her to a hospital for evaluation. As you can imagine, this helped to move the conversation along.

The final decision came down to numbers. My youngest brother and I were in agreement that Mom could not return home. Our united front was enough to sway our middle brother. My oldest brother was not convinced, but chose to accept the majority rule.

This is a quote from the assisted living facility's brochure:
The layout is residential by design - small in scale and organized into four self-contained "houses." Each house has its own living room, dining room, kitchen, full bath and laundry. There's also a secured backyard for gardening and enjoying the outdoors.
"House" is a bit of a misnomer. The houses are wings off a central common area. The common area includes a library, hair salon, recreation room, music area, and large activities area.

Each wing has a max of thirteen residents, making the entire facility resemble a living deck of cards with 52 total. And, like a deck of cards, each suit has its own color scheme around which it is organized. The Green House, where Mom lives, has wallpaper with green borders and hints of green throughout the furnishings. Mom has a private corner room and half bath. Here's a photo of a house dining room with its three tables for the residents.

Note the door to the outside. Mom's house has at least three doors to the backyard that are kept unlocked until darkness. Multiply that times the four houses, and you realize just how open the living plan is. I walked out one of the doors early one evening and saw a deer on the other side of the back fence.

Of course, the setup is such that, although the residents are free to go outdoors, they cannot leave the backyard. There's a gazebo, and picnic tables and an old-fashioned porch swing.

One of my brothers--I don't remember which one--described the place as "Disney World for 80-year-olds."

Disney World doesn't come cheap. We're paying over $5,000 a month.

Understand, none of us begrudges the money. We recognize how lucky we are to be able to afford her care. Her occasional bouts of physical aggression and her very strong streak of independence would make it tough for one of us to keep her in our home although that possibility was the one we were entertaining when the police arrived at her house and forcibly removed her. She spent a week in the hospital tied to a bed.

However, when you add in the cost of the cocktail of medications Mom takes daily, we're running through her savings at quite a clip.

My youngest brother, who bears the burden of oversight, called me early this month. We had to do a review of her financial situation and move some money around to make arrangements for the next year of care.

My middle brother, his wife and daughter flew to Florida and spent last week visiting Mom.

She's good. She can hold it together in a social setting and waited until he had dropped his wife and daughter off at the hotel before asking, "Who were they?"

I call Mom almost every morning as I drive to work. I *think* she still recognizes my voice although I'm always careful to identify myself by name. In ten minutes of conversation, we talk about the weather about four times, and she asks me at least that many times how I'm doing.

It's hard to say whether I miss her more while we're talking together on the phone or when we are not.

Sunday, May 01, 2011

I'm Back

After two months off, I'm back. Sorry for being AWOL, but I needed some time to myself to regenerate.

I finally accepted that I will NEVER use my gym at 6:00 AM. It's just not gonna happen. I'm now exercising at 10 PM five nights a week, and it's working. I've got eight weeks behind me and am feeling great.

Thought I would start out with some fun.

Here are two clips from the White House Correspondents' dinner last night. The first is President Obama's speech.

The second is Seth Meyers' remarks. Seth is, of course, from Saturday Night Live. You can find his roast of everyone and everything in American politics on YouTube here.

Have a great day.