A Time to Look Back

In a few hours, 2017 comes to an end and a new year, 2018, will be ushered in with fanfare. Already, several countries around the world have showcased extravagant New Year celebrations. Millions of people across the world from Austria to Australia, China to Chile will celebrate with fireworks and parties, the exuberance of a new beginning.  It’s good to put the past behind and look forward to the possibilities and expectations of a new year.  However, before we move on, I would like to take a last review of what 2017 was for me.

Looking back one can find moments of joys and sorrows, moments of exhilaration and times of foreboding, moments of ecstasy followed by times of grief. That’s typical for any year, but 2017 was particularly noteworthy for those emotional swings. Here are a few of those encounters which are etched in my memory.

 In April, I celebrated the ten year anniversary of my diagnosis with nasopharyngeal cancer. But within a few days, I was informed by dermatologist that a suspicious nodule removed from my inner left leg had tested positive for angiosarcoma. After requesting a second opinion, it was confirmed that the initial diagnosis was correct and I now faced a protocol that would include surgery to remove a larger swath of tissue from the offending area followed by six weeks (30 sessions) of radiation therapy. The first attempt of surgery was suspended after anesthesia was administered because the doctors encounter difficulty performing an intubation as a result of the traumatized and scarred oropharyngeal pathway from treatment 10:years prior.

After a second successful attempt at surgery, and before the radiation began, I received the sad news that my 95 year old mother was hospitalized. She had suffered a fall, which by itself appeared innocuous. However, accompanied by suspected pneumonia, she quickly declined and passed away on September 29. I postponed the start of my radiology treatment to travel to Tobago, where along with my siblings and scores of relatives and friends, we were privileged to pay tribute to our dear mother as she was laid to rest on October 8.

I completed my radiation therapy on November 29. It was also the day on which my wife, Nichole had surgery for a seriously torn rotator cuff and biceps muscle. We were both incapacitated for several weeks - she, painfully enduring the post-op pain, and I, hobbling with the raw deteriorating skin as a result of six weeks of radiation. 

As we both improved, we received news that my now widowed, 99 year old Dad had experienced several falls. As his muscles wear weak and his sight fails, he finds it more difficult to keep his balance. But old habits and manly ways along with the tendency to suppress his desire to be active lends to the habit of perhaps taking too many risks that a 99 year old should avoid. The mild bruises and short hospital stays nonetheless, he carries on towards the landmark of one hundred years.

As Christmas approached, we received news that our older brother was admitted to the Scarborough General Hospital in our island home, Tobago. He had experienced several hospitalizations over the last few months and this time appeared ominous. The new year will begin with him clinging to life after being medivaced to the larger and better equipped  San Fernando General Hospital on the larger sister island of Trinidad as he tenuously clings to life.

What a year! Despite the foreboding of Junior’s health, hope springs eternal and every day, every year, bears promises of love and laughter amid the pain, sorrow and hurts that are a natural part of living on this earth. I am grateful for a loving, caring wife, two devoted children, three wonderful grandchildren and blessings too numerous to count.  I look forward to the Centennial celebration of our dad, Henry - his 100th birthday. What a celebration that would be!  “For everything there is an appointed time, and an appropriate time for every activity on earth:”

‭‭Ecclesiastes‬ ‭3:1‬ ‭NET‬‬

http://bible.com/107/ecc.3.1.net

Love and blessings, always!

When Rituals Find Meaning

I grew up in a Seventh-day Adventist Christian home. We Adventists are peculiar in a way unlike many other Christian denominations. Like the Jews, we honor the seventh day of the week, Saturday, as a Sabbath - a day on which we set aside the routines of weekly activity, and rest - essential services exempted. Rest, meaning casual, relaxed, respite, different., change of the routine. There are a wide variety of Sabbath activities among Adventists. For some, it's going to church with the family, enjoying family meals in a less hectic environment - in a relaxed atmosphere. For many others, it may include a quiet day at home reading; being with the family, or enjoying a jog or bike ride alone or with friends; a hike in the forest or a gentle stroll through the park. For some others, it's an opportunity to visit those confined by illness, incarceration, or the limitations of aging, visiting hospitals, prisons, nursing homes.

But there some practices that have become rituals. One of those rituals is the way we greet each other. As the sun sets in the western horizon on Friday evenings, the greeting that transcends all and in every language imaginable is: Happy Sabbath! Shabbat Shalom (Jewish), Feliz Sábado (Spanish or Portuguese), Bon Sabbat (French), Salanapa Sabadi Kadepa Gogodala (New Guinea), Sabato njema (Swahili), Gelukkig Sabbat (Dutch) and hundreds more. "Good morning" or "Good day" is often reserved for the rest of the week or selectively used for those presumed to be not Adventists. It has become cultural lingo. It is a greeting that acknowledges the feeling of end-of-the-week exhaustion and gives one a sense of relaxation; of calm exhalation of the previous week's load of responsibility and an opportunity to project hope for the week ahead. Rest, respite, reinvigoration, relaxation, revitalization!

In Jewish tradition, whenever another celebration or holiday fell on the weekly Sabbath, it was regarded as a "high" day - an opportunity for a double celebration. As eventful as this week has been, the news just got better, and Sabbath, sweeter. In a way, a high day! My oncologist texted me early Friday morning because, as he said, he wanted me to wake up to good news. The text was as follows:
"Mr Archer, sorry to text you so early, but I wanted you to wake up with good news: no cancer on the lymph node nor the scar."
That was the Pathology report.

So, with the deepest, sincerest meaning possible, "Happy Sabbath!" It's a high day!

Love and blessings,
Len

I Shall Return

Yesterday, Wednesday August 23, 2017 was a good day. With the help of expert otolaryngologist, Dr. Scott Magnuson, who managed my airway to facilitate intubation, surgical oncologist Dr. Sebastian De La Fuente successfully conducted the planned excision of tissue around the area that had previously tested positive for Angiosarcoma. In addition, he removed some inguinal lymph nodes for biopsy.  I am indebted to these dedicated surgeons and the wonderful team of caregivers at Florida Hospital Celebration for their professionalism, compassion, and caring, including the two nuclear medicine graduates from Adventist University of Health Sciences who did my NMR/CT scan the previous evening. I could not be more proud when receiving care from these ADU graduates, who along with the entire team demonstrate the mission of Florida Hospital - extending the healing ministry of Christ.
Although the surgeons had previously planned on a one-night hospital for observation to ensure my medical stability, I was discharged at the end of the day with the opportunity to rest at home in the comfort of my own bed. The intubation went so smoothly that I have had no oropharyngeal discomfort; only slight soreness at the surgery site but no post-op pain. Due to my limited mobility, I am expected to rest up up for a few days as healing progresses and I plan to return to work when my pain threshold and mobility allows. The results of the lymph node biopsy will determine whether further surgery will be required and whether chemotherapy will be needed. However, after healing of the site, in about six weeks, my radiation treatments will begin.
But permit me to share another war story.  Between 1939 and 1945, Allied Forces on the Western Front, primarily from Britain, France, and the United States accompanied by many other European, Australian, African, and Asian forces, fought valiantly against the Germans. Seizing on the preoccupation of the United States in the European theatre, Japanese forces unleashed an unprovoked attack on the United States at Pearl Harbor, Hawaii. General Douglas MacArthur named the leader of United States Military Forces in the Far East during that time. After numerous losses, MacArthur and his family were forced to retreat to Australia. He then gave a speech in which he famously promised the residents of the Philippines and the islands of the South Pacific, "I shall return." After more than two years of fighting in the Pacific, he fulfilled that promise. Return, he did! For his defense of the Philippines, MacArthur was awarded the Medal of Honor. He officially accepted Japan's surrender on September 2, 1945, aboard the USS Missouri anchored in Tokyo Bay, and oversaw the occupation of Japan from 1945 to 1951.
Millions of men around the world joined the Allied forces, including thousands from the colonies of the expansive British Empire around the world, many of whom volunteered to fight against the forces of Germany and Japan. American and British generals were hailed as heroes among the colonies as the allied forces fought valiantly to defeat the forces of racism and fascism. My parents named me Len McArthur Archer - my middle name (spelling nonetheless) a tribute to the great American general who was venerated by many colonials of the British empire after the war. I grew up knowing that the name evoked emotions of resolve, grit, and promise. 
There are many things worth fighting for, or at least making a valiant effort to achieve. In spite of the challenges I have experienced in recent years, rest assured that the grit and determination of the  iconic MacArthur is mine. I look forward to a full recovery and back to work and play, and the love of family and friends.

I SHALL RETURN!

Love and Blessings,
Len

Fit For a Fight

I love athletics and have participated in various sporting events all my life.  As a highschooler, I was on the track and field, cricket, football (soccer), and table tennis teams.  I have never considered myself greatly skilled at any of them and I performed best as a cross country and middle distance athlete.  I never began seriously training for track and field until I was about 17 years old. In fact, for most sports I just played casually and showed up, but I loved to run. In football (soccer), I didn't juggle the ball with my feet or head as well as some could and my small, skinny stature made me less likely to maintain possession of the ball when tackled by bigger, stronger opponents, but good enough to represent my high school and play for my local amateur team in the island league. In cricket, I had the eye-hand coordination that was necessary to be average but since I did not spend a lot of time practicing, I never gained what it took to excel to a regional or national youth team.
So what was my secret? If you were as good as me, I'd win! If you were just slightly better than me, you'd lose! Why? Because I could run all day and would never give up. I was a pest on the pitch (or field, if you like the American terminology).  If winning required a final sprint, I would be dying before I gave up. So, you would need to be better than me, because you would likely not have the will to keep going as long as I would.  I had, what my classmates at school called "guts" to outlast you.  I'd die only after you did.
After moving to Orlando in 1993, I started running more frequently, completing eight Disney marathons and a half marathon. I didn't run or train extensively so my times were hohum but I never quit. In 2004, I started roadbiking with my son who had recently returned home from college. It was an opportunity for us to be active together. My riding buddies know that they can count on one thing - whether its a 20 miler of a 100 miler, I would only quit if forced to due to serious injury or illness.
I guess that it is just my DNA, because that philosophy extended to my academic career.  I encountered numerous set-backs while working on my dissertation research - lost data, failed equipment, accidental destruction of research materials. Although often deflated by the experiences, the only thing that I never considered was quitting.  That may not always be the wisest choice, but for me it always seems the only choice.
As in 2007 when I was diagnosed with nasopharyngeal cancer, I now face the daunting future of another cancer diagnosis - angiosarcoma.
During World War II, British Prime Minister, Winston Churchill gave numerous speeches to rally the British people in the face of an advancing German army. One of his most famous included phrases that have been modified and used hundreds of times: "We shall never surrender...we shall never, never, never give up!"
On my recent trip to Trinidad and Tobago, I contracted a viral infection and developed symptoms of constant sneezing, a slight fever, and a cough that indicated a mild chest infection. More concerning, I also began to experience night sweats. I was scared. Scared that my night sweats were a sign of cancer metastasis and a bleak outlook.  By the time I returned to the US after an eight hour flight delay and lack of sleep, I was exhausted, scared, and depressed. For the first time, I felt like giving up - a feeling I had not experienced during my episode of cancer 10 years ago. After a long night's sleep that extended through the next, I felt stronger emotionally and physically. I now feel energized and ready for the fight. There are things in in life worth fighting for. I won't ever give up on my family. I won't ever give up on my marriage, and despite the many questions I sometimes have about religion, I will never give up on God.
Thanks to the hundreds of you who have expressed, in various ways, your love and support - thinking of me, praying for me, encouraging me, sending notes (please no memes) and even those silent, unspoken fears of what this may mean; and I can't omit my biking brothers who prayed for me on my last ride before my rescheduled surgery at 8:00 a.m. on Wednesday, August 23. This I know! I plan to face this challenge the only way I know. To smile, and maybe cry and to display guts and courage. My goal is to return to good health; to return to join my friends riding for a long bike ride; to continue to bask in the love of my wife, children, and precious grandchildren. I will fight this setback the only way I know - I will never, never, ever give up!
Love and blessings!
Len

The Unsuspecting

I am facing another health challenge. On May 20, 2017, I visited a dermatologist to remove a nodule I believed to be remnants of a bike sore - the result of continual friction between skin tissue and fabric. After all, we road-bikers occasionally get these small annoyances after riding for long hours. The excised tissue was sent to the Florida Hospital Pathology lab for analysis.  Several weeks later, the dermatologist called to inform me of the results of the pathology test. "I am concerned about a Pathology report I have received about the nodule I removed a few weeks ago. The Pathology report indicates a positive test for angiosarcoma. I would recommend that you see an oncologist. Do you know one?" It seemed like a lot of information to absorb; but it had been only about 20 seconds since he had greeted me with "Mr. Archer, how are you?"  "Please fax me the report immediately and also send it to my oncologist," l responded, while providing him with my oncologist's contact information. "By the way, please also send a copy to my Primary Care Physician." On receipt of a copy of the report, I scanned it and emailed it to my wife and children.
I have been blessed with a wonderful family. My wife is the ultimate homemaker and caregiver. My son, a hospital executive, is thoughtful and analytical. My daughter, a lawyer, has an eye for the detail that many of us might miss along the way. Later that evening, as we met to discuss the next steps, we decided that we should have a second opinion, another Pathology review of the tissue.  Several days later, the second opinion, performed by Moffit Cancer, confirmed the first. It was described as epithelioid angiosarcoma, a cancer of the lining of the blood and lymph vessels.(http://sarcomahelp.org/angiosarcoma.html). Unsuspecting! (By the way, this is totally unrelated to my experience with nasopharyngeal cancer in 2007.) 
Whether there was metastasis or not, was at this time concerning as the cancer cells were too close to the margins of the incision. Suspicion loomed and a reexcision was recommended. My oncologist ordered a PET scan which appeared normal. Good news! A team was assembled to review my medical status and make the appropriate recommendations. The surgical oncologist and a radiation oncologist collaborated and came up with a treatment plan. Surgery (a wider excision) followed by radiation. 
An initial attempt of surgery was terminated due to complications during anesthesia. My trachea became extremely scarred, narrow, and warped during my radiation treatment in 2007. As a result, intubation during anesthesia is risky. In 2012, a failure to complete intubation during anesthesia resulted in a tracheotomy. My surgeon therefore decided to abort anesthesia and suspend surgery before the critical decision to perform a tracheotomy. 
After a life of relatively good health, with a fairly active lifestyle, this was an unexpected diagnosis and is a reminder of the tenuous nature of life on this planet. Although I had a normal PET scan, the risks are obvious, but the prognosis can be described as guarded to good. At this time, I am prepped for radiation and after a short time away visiting my parents in Tobago, I will make a decision regarding another attempt at surgery, or proceed with radiation only. My previous experience with cancer, notwithstanding, I am hopeful and I look forward to a rapid recuperation and full recovery. 

Love and blessings!

Len