Help...and some details

As most people who know me know well, my dad has leukemia. That's Acute Myelogenous Leukemia, AML for short, code number 205 (ICD-9 code, for you docs). It's super. Pick up the sarcasm quickly. There are three critical pieces to blood and leukemia depletes ALL of them; here's what they do:

1 - Red blood cells: These store and carry oxygen around the body (along with other things). When you don't have them, you don't have enough oxygen and nutrients in your system. You get tired, short of breath, you can't walk up stairs, talk, function well, etc.

2 - White blood cells: These fight off infection. Period. If you don't have them, your body can't fight off anything, even the smallest little cold or sneeze. A normal person has a range between 4,300 and 10,800 cells per cubic millimeter (cmm). This morning, my dad's WBC count was 0.3. That's 300 cells per cmm. Not that many little cells with boxing gloves, ready to take on the latest fight.

3 - Platelets: These allow your blood to clot. If you are missing these, the slightest thing leads to bleeding - either externally or internally (= a 'hematoma,' or a bruise of varying seriousness). Normal platelet counts are in the range of 150,000 to 400,000 per microliter. My dad's today were 6. That's 6,000 platelets per microliter. If he falls walking up or down the stairs...well, I'll leave it at that.

Leukemia kills off all of these. There are ways to cure it. Mostly through a Bone Marrow Transplant (from yourself or from a donor). There are also ways to fight it off. Chemo. Blood transfusions. More chemo. Expensive drugs that cause white counts to rise. Other types of chemo. Everyone responds differently. Everyone. Unfortunately, we're approaching the end of the road. All those options are only options so long as the risks and benefits outweigh the costs. And if they are not effective in fighting the leukemia, or put the heart excessively at risk, or kill all of the working grey matter in a person's brain -- well, they somehow lose their rosy potential.

My dad is an excellent patient. He's cheerful (less so lately, but give him a break, he's exhausted), interesting, jokes with the doctors, remembers the names of the nurses, doesn't complain of pain (even the numerous needle sticks), analyzes all situations and most of all does not give up. The latest prognosis -- of 3-6 months, the first time anyone's mentioned time or the lack thereof -- he met with the following comment and a shaky smile: "Damn the torpedoes, full speed ahead." It's amazing to be around him. He's an inspiration to me and to others, especially those in my family who get to see him and hang out with him lots. Many nurses and doctors have warmed up to him, even the tough ones. I can imagine how difficult it is for them. Especially working in Hem/Onc ("Heem-Onck" = Hematology and/or Oncology) they have to steel themselves against losing their hearts to their patients. Because the odds are not with everyone, especially not among these chosen few, and people don't last forever. They shouldn't. It doesn't make it any easier, but it's true.

Many people, upon discovering or learning more about the situation, tell me (or others in my family), "I'm so sorry; let me know if there's anything I can do to help." Help. It's a difficult term, and one that I aimed to dedicate this entire post to. It's critical for people who are existing together and caring about each other to help one another. It's what builds friendships and communities, and reminds me of the ancient parable:

“A Chinese parable describes the settings of Heaven and Hell exactly alike: Each is an enormous banquet with delectable dishes on huge round tables. All are given chopsticks five feet long. In the banquet in Hell, people struggle to manipulate these awkward utensils, give up out of frustration, and starve. In Heaven, everyone serves the person across the table and each becomes abundantly full.” -- Chungliang Al Huang & Jerry Lynch, Mentoring: The Tao of Giving and Receiving Wisdom, 1995

But while help in the broad sense is easy to offer, and so, so much appreciated, it's tougher to do at the 10 and even 1-foot level. And it's very difficult to plan for and plan around. Before I get started, they are ALL appreciated. It's just that some make a real, true difference. There are different levels of help. Write an email? Causes warm fuzzies. Send a card? Write a note? It brings a smile, and is kept. Call and talk to me? Wonderful. Call my mom? Even better. Send food? Can be extremely helpful, especially if it coincides with a really needy time. Feed the dog? Walk her too? What about two times in one day? And if Molly makes a mess because she's old, are you willing to clean that up? All helpful, but I certainly temper what we ask for and from whom. I'm not willing to put someone in a difficult position, but it sometimes is that. What about being a driver? My dad goes into San Francisco almost every day for a treatment, an infusion, an appointment, or to the hospital for an overnight+ stay. It's a 45 minute drive each way. Plus parking. Plus walking with him. Taking notes on everything. Making sure he has what he needs at all times. It takes a tremendous amount of faith to entrust someone whom I/we love, who cannot fall, ever, to a friend.

There's the help that can be planned for, and there's the help that cannot be. Today my mom and dad checked out of the UCSF hospital after a week-long stay and were in the car ready to go when my mom's car died. Done. Kaput. Recall my dad's current blood counts. He can't be outside for long, he can't ride in a dirty tow truck, he can't sit in a hospital waiting room where sick people sleep all night long, and he's tired. Can't stand up for long, and can't walk very far. Today worked out fine; I was available so I jumped in the car, drove to SF and picked him up. I called a few people to see if someone could pick up my mom at the car place (I could not now leave my dad alone...), but the friendly helpful tow truck driver offered to take her. Phew. We all arrived home around the same time, and shortly after that, pizza showed up. One of mom's staff members and a 'savior' per my dad had realized the stress that the car caused and sent over some dinner. YAY. :)

The trouble with help is that it's inconvenient. The most helpful things require someone to go very much out of their way to do something for me or my family. And those people I will never, ever forget. That kind of help stands out in a way that few people do, ever. There are only a few people in my life who will voluntarily sleep at my parents' house and wake up at 5am to calm me down and help get my dad to the emergency room because of a fever. Few people who will come over three times in a day to make sure Molly is ok. And this is the tough part. You never know until you need it and you ask that you can really count on someone. Or not.

Help. Yes, I need it. We all do to varying degrees, depending on our current and future states. To those who have offered, thank you. To those who have not only offered but have helped, you are wonderful. And to the special people in my/our life who are willing to put themselves last to alleviate stress, pain and difficulties, you are a guardian angel. We all need more of them. I feel grateful that I am able to fully appreciate the extent to which help helps. And I hope that I am in a position someday to be able to pay it back or pay it forward - whichever you like.

So the next time you offer to help, just make absolutely sure you ponder it a bit harder before you say it. Do you mean it? Really? Let me know which level of help you can do. Because I might have to count on you. It might be the middle of the night. And you, even with something small, even by missing an event to stay with Molly or visiting in the hospital, can make all the difference. I mean that.

Thank you. Profoundly.