This is coming to you from the Huntsman Cancer Institute… but how did we get here and how long will we be staying? Let me tell you.

One week ago, last Monday, Mark had CT scans to determine the effectiveness of the immunotherapy. We had a virtual visit scheduled to occur today, one week later. However, that evening we received a phone call that the doctor wanted the visit moved up to Wednesday morning. This worked out fine because we would not be leaving for our Thanksgiving vacation until around noon.

As we chatted with Dr. Chalmers we were stunned to see the most recent scans. Cross sections of the lungs showed a marked difference between the right and left side. The right lung was mostly black, indicating air with a few small tumors here and there. In contrast, the left lung showed about half of the air space with irregular, lumpy linings. Had the tumors grown that large or was it fluid again? It was inconclusive, but measurable tumors definitely indicated the need to move from immunotherapy to chemotherapy right away. Mark already had an infusion appointment for the following Wednesday but because of work we were hoping to get it moved to Friday.

One question remained. Which chemo option would be best? We could begin with the doubled-up drug scenario they had planned six weeks before, we could do that for two rounds and then drop the stronger second drug, or we could begin with the first, more mild drug and then add the stronger after two rounds if necessary. We decided to go with the third option. Then we packed the car and headed on our way.

Our family gathering was to be at a cabin in Monticello, UT. There is really nothing there, but it was a relatively central gathering place. Because of cruise control Mark was able to drive for a couple hours and then helped to unload the truck before everyone else arrived. He was a bit short of breath but this has been normal for quite some time. The next morning was Thanksgiving. He had a fitful night and when he woke up the breathing difficulties had increased.

Concerned that the fluid was filling his lungs again we called Huntsman to get some advice. As I waited on hold Mark learned Monticello’s elevation was 7000 ft! Nearby Moab is just 4,000, about the same as home. The doctor told us that if we went to any emergency room around there they would ship him up to Huntsman. She said we could expect a call from the hospital on Monday to have him come in for a possible thoracentesis. This was kind of a bummer because we were planning to stay at the cabin until Monday… (ummm, I just realized that is today!). She also said that if his breathing came more easily in Moab (we were going on Friday) that he should stay there.

Throughout Thanksgiving Mark sat quietly. Other than that he was able to eat, play games and interact normally. We determined that we could all go to Moab on Friday where we had scheduled a photographer for family photos, and then he could return to Monticello and just continue to sit quietly. Most of our children needed to leave Saturday afternoon so that they could get back to school. Others would leave Sunday morning and Mark and I had planned to stay and enjoy time alone together until Monday. It was beginning to look like he would go home Saturday afternoon with the college kids.

Cancer had other plans for us. When I woke up early Saturday morning Mark was sitting up in bed rather despondent. When I got his attention he said he was dizzy… very, very dizzy. I had the impression to wake up David and have him take Mark home immediately. Kimberly could come through town later and the two of them could make their way back to college while Jackie and Natalie stayed with Mark. David was up, packed and ready as quickly as possible, but it took us about an hour to get Mark in shape to leave. Not only was he dizzy, he probably threw up seven times in that hour. Our three sons had to “carry” him to the car. They had a four hour drive ahead of them and all that I could think of was getting Mark to a lower elevation.

About an hour after they left I had another impression. Forget going home! Get Mark right to the hospital. I texted David these instructions. Mark was insisting that he just wanted to go home and sit in his chair and he would be alright. I told David that Dad didn’t have enough oxygen getting to his brain to make these types of decisions and to just get to the hospital. Not long after this Mark called to tell me he wanted to go to the hospital – a sure sign that something is wrong.

He spent one of those fun Emergency Room afternoons at the University of Utah and was then admitted to the Huntsman Cancer Institute. We learned that there was no fluid on the lungs, those large lumps were indeed tumors. Some of the large tumors in the lining of the lungs are causing parts of the lungs to collapse. There are tumors pressing on the pulmonary arteries so there was talk of placing some stents. There is also a tumor pressing on his heart which explains why his labs were showing an increase of enzymes which would otherwise indicate he had undergone a mild heart attack. (He didn’t.) It turns out that the stents were not really an option because the tumors are in the way. They thought that some of the smaller tumors which are inside the lungs (most are in the lining) are now hemorrhaging and this explains why they are always asking if he is coughing up blood. He isn’t and I don’t know the significance of this.

We went to bed that night without a clear plan, but knowing that he was not in good shape.

Meanwhile back at the ranch, our adorable granddaughters and their parents headed home. Greg had stayed behind to drive with me so we also left the cabin a day early to get back to Mark. At the hospital they were once again working out what would be the best chemotherapy route. The only thing we really knew was that there was no way they were waiting until Friday! Mark had been on oxygen and his brain was cleared up so that was a relief.

By the time I was home we decided that I would just stay for the night and join him today. The doctors decided (and we agreed) to jump right in with the hard stuff and begin chemotherapy today. It was scheduled for 3:00 and by the time I had completed all that I needed to do I was sorry to get here to Huntsman at 4:00. However, true to hospital time chemo had been moved to 6:30. Mark also had a picc line put in – he will need to have a port placed before the next infusion but with time being of the essence we couldn’t wait.

I think it is an interesting chemo schedule. He began with doxorubicin being given as a slow 5 minute push. Then they administer the second chemo, Ifosamide, over three hours. The timer just went off as I am typing, so they began the flush. We thought that they had to flush it for a few days, but it turns out that they actually administer the chemo for four days in a row, 22 hours apart. Some good news is that because our tumors are so aggressive, the aggressive chemotherapy will be more effective – it goes after those super fast growing cells.

For the next five months we will continue to come to the hospital for a 4-5 day stay, then be home for two weeks. They are able to control nausea quite well so we will see how he handles it. I am sure he will do very well. There will be the usual chemo side effects such as hair loss and exhaustion. Our plan is then recovery and getting on with a productive life.

It would seem that our minds would be reeling from all of this. To be honest, we are calm and peaceful. If my mind is reeling about anything… it is reeling from the many wonderful things that have been happening in our lives. The multitude of tender mercies we have experienced. I hope to share some of these soon, but for now I am exhausted. Mark is already asleep and I will have the fun of sleeping on this couch in his room. It doesn’t matter, I am glad to be here. It isn’t quite the same as our extra day at the cabin, but time together is precious!

…now, after all of that, do you need a smile? Jackie was with Mark as he was admitted to the hospital and she sent me the following conversation:

Nurse: How do you learn best?

Mark: I learn best when you tell my wife when she gets here.

Nurse: Yeah, we hear that one a lot. It’s a very popular method.