My head may be in the sand but I can still hear you

Many people on a beach with their heads in the sand

While everyone else was back-to-school shopping, I was back-to-size-8 shopping. I wanted a few clothes that fit my new body, however temporary, so I scoured every sale rack I could find. I didn’t buy much since this petiter me may be fleeting, but I was tired of looking schlumpy while my body sorted itself out.

No, I haven’t gained all that weight back. Rather, I’ve lost another kilo in recent weeks. No wonder I was nervous about yesterday’s appointment with Dr. Blood Lite. “I have been eating more,” I told him, “but not enough to gain weight.” Although I feared his wrath, he is too kind to be angry.

After discussed my leukemia, which seems to be stable, he asked whether I’d ever reviewed the progression of my liver disease with Dr. Foie Gras. Where did that question come from? I told Dr. BL that, no, Dr. Fois Gras and I had not discussed my liver’s prognosis, but likely because I had never asked.

As much as I want all the information I need about my various ailments, I don’t want it before I need it. I may not ask the questions but I still know what the potential outcomes are. I told Dr. BL, as I’ve told you, my faithful readers, that I can only think of one of my illnesses at a time or my anxiety overwhelms me. Mostly I pretend I only have leukemia and forget about all that other potentially deadly stuff.

For many years, I have been low on my liver doctors’ totem poles; the patients they focus are often in acute liver failure or have more aggressive liver diseases. They need liver transplants or they are dying. I was one of them once, about five years ago to be exact, but I’m not right now. I only think of myself as someone with liver disease when my liver is malfunctioning. I know what a failing liver looks like, but I choose not to ask for details.

I see Dr. Fois Gras every six months or so, he takes a closer look inside me once a year, and he reviews my blood work quarterly. My blood test results have never garnered a telephone call from his office. No news is supposed to be good news, right?

Usually my denially approach works, but it failed last night between 12:30 and 3:30 a.m. when I stared at my ceiling, listening to both J. and the dog snoring, and wondered if something was terribly wrong with my body and no one was telling me. Maybe Dr. BL was afraid to share his concerns after I’d put on my blinders in front of him. Or maybe he was being thorough since he didn’t know me all that well. It must be the latter.

If he were that concerned, he would have told us to cancel a trip we’ve planned, but he didn’t. He encouraged us to go even though it’s very far away. He even mentioned that our destination country is known for many well-respected hematologists.

You might wonder where we’re going, but that will have to wait for another post. First, I need a good nap.

 

 

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Introducing Dr. Blood Lite

This one’s for you, Janet.

You may wonder who this Dr. Blood Lite is, and how I named him without consulting you first, my dear readers. This time I didn’t need your help, thanks to a comment on a previous doctor-naming post. In that comment, a beloved beer connoisseur, who would never imbibe the beer of the masses, came up with this perfect name.

If you haven’t yet put one and one together, Dr. Blood Lite is Dr. Blood’s locum for her sabbatical. He is a lovely young doctor and, since he’s been trained by Dr. Blood, I know he’s learned from the best. Dr. Blood had told us she had considered her replacement carefully, and she hit the jackpot. Dr. B.L. seems calm and kind and he even introduced himself using his first name. You know how I like to be on a first-name basis with my physicians. It gives me a false sense of collegiality.

Although I did not recognize the newbie, we had met once before when I was an inpatient on the hospital’s palliative unit. Do you recall that hospital stay, the one where the hematology unit was full so I ended up lodging with the dying people? I could not remember him but J. clearly recalled Dr. B.L.’s Edmonton Oilers lanyard. In fact, I envision her hijacking my future appointments to talk about McJesus. That Dr. B.L. could remember our brief encounter is a miracle on par with McJesus’s MVP performance last year.

Back to my health for a moment. Dr. B.L. told me that, if my blood work is to be believed, I am holding steady on all fronts. This is good news. There are no significant changes since last visit, which means I will stay on my current treatment plan.

My blood work did not explain my appetite loss, which was a relief. I had pretended I wasn’t worried about my disinterest in food, but I was lying, as you probably suspected. I may have a perfectly reasonable medication-related explanation for the pounds melting off me, but as a graduate of the School of Something Could Always Be Seriously Wrong, I’ve still wondered whether my liver might be tanking. As of today, I worry no more. My liver is a-okay.

Despite my apparent well-being, Dr. B.L. was alarmed by my rapid weight loss. So alarmed, in fact, that he said something that no doctor has ever said to me before: he told me to start eating more. He forbid me from losing any more weight and said he expects me to pack on a few pounds by the next time I see him. He even suggested ways I might increase my caloric intake.

My inside voice could not help but giggle in response to Dr. B.L.’s concern. I wanted to say, “Do you realize who you are talking to? I am a glutton! Cookie Monster is my doppelganger. Or is it Miss Piggy? Whatever, you’ve got me all wrong, doc.” Instead, I listened respectfully and told the doctor I would take his concerns under advisement. Yes, I used those words. And he smiled, just a little. I think we’re going to get along.

Now I must force feed myself some dinner. Doctor’s orders.

arm reaching table full of appetizers

Ah, ha, ha, ha, stayin’ alive

 

Did you miss National Cancer Survivors Day yesterday? Not to worry, so did I. I scored nary an invite to any of the festivities. I’m not even sure I am a cancer survivor; all I know is that my cancer hasn’t killed me yet.

Turns out I’ve got a good cancer, if there is such a thing, one that people can live with for many years. And since most of the time I’m in complete denial about my co-existing conditions (my impaired liver and my polycythemia–Happy 17th Polycythemaversary, by the way), I can pretend I too will be one of these people who will live a long life.

One of the main reasons I don’t feel like a true survivor is that I still take daily medications to keep my leukemia at bay. Oh, and my regular visits to the Cancer Centre. There’s nothing like hanging out amongst my cancerous peers to remind me I’ve still got the big C.

Unlike many other cancerous folk, I have very few leukemia cells now, according to most recent testing. So few that, in a CML patient booklet I just read, I am considered in remission. No one has used the R word with me before; in fact, when I was first diagnosed, I was told people with CML don’t go into remission. I was as surprised as you may be. If I’ve misled you, I did it unintentionally.

I also learned from that informative booklet that, with the advances in treatment of CML, many of us are living to a ripe old age. The focus of intervention has shifted from treatment to our quality of life. That part I get, now that I have reached Day 7 of The Wrath of the Gouty Finger. The leukemia isn’t so bad; it’s the symptoms and medication side effects that I find challenging.

So I’d like to suggest a new day of celebration more appropriate to those of us with CML. Let’s call it National Cancer-Symptoms Survivors Day. We’d be celebrating maintaining our quality of life while living with the threat of a potentially terminal illness hanging over our heads. We gatherers could compare notes on our various medication side effects and how we have survived them. We could share information about the interventions we’ve added on to manage those side effects.

I can think of many ways such a get together could benefit me. I’m sure there’s a CML survivor out there who would know how to manage yoga postures that require my lying on my belly. “Do you also have to rearrange the position of your football-sized spleen when you lie down?” I’d ask. Or how about our unrelenting fatigue? “Do you too fall asleep during matinees? How do you keep yourself from snoring?” Then there are the challenges of taking all those drugs. “How do you manage to time your medications to minimize all drug and food interactions?” The possibilities are endless!

We’ll plan our special day to coincide with the National Cancer Survivors Day. Then those of us who feel left out will have somewhere to go where we feel a sense of belonging. We all need to feel we belong somewhere.

Cut out figures holding hands

Fatigue is a many-splendoured thing

I’ve been struggling with more fatigue than usual of late. I should be napping daily, and on the days that I don’t, despite my best efforts, I spend part of the day in a fog. Last Monday, I napped before my volunteer shift so I’d be able to serve soup safely.

Despite my fatigue, I dragged myself out of bed this morning so I could write this post. If I let myself, I could return to bed and sleep for another few hours. My self-denial does not allow for the stimulating effects of caffeine. I am hoping writing will get my brain cells firing.

I try not to belabour you with stories of my fatigue day in and day out. I’d hate for your reading to put you to sleep. And I don’t want you to view me as a whiner. But since people often ask me why I’m tired, I thought I might list the known reasons here.

  1. Medical factors:
    1. Leukemia (I expect you to know that one)
    2. Polycythemia (maybe less obvious)
    3. Liver disease (yes, my sick liver makes me tired)
    4. Related to C, pharmaceutically-induced low blood pressure
    5. Several other medications with those little warning stickers on the bottle, “Do not operate heavy machinery….”
  2. Environmental factors:
    1. Bedroom is too hot/too cold/not just right
    2. Pesky songbirds that awaken early in these parts
    3. Pesky dog who takes her cues from the pesky songbirds
    4. Stanley Cup playoffs

Let’s focus on 2D, since the playoffs, however transitory, are currently compounding the chronic fatigue caused by medical factors (1A through 1E). Now that Calgary is out, I am rooting for the Edmonton Oilers under duress. They are making a notable run for the Stanley Cup. Now in the second round, they continue to play brilliantly, despite last night’s loss.

The Oilers’ performance should be of no matter except (and this is a big “except”) their games have been taking place late in the evening. Because I am a devoted hockey pool member with players selected by my beloved (my love for hockey only goes so far), I am invested in how well all teams are performing.

(For the benefit of those who do not know what a hockey pool is [primarily my family], I choose the well-performing players from teams I believe will have success in the playoffs. [Liar. J. chose my players.] Players are eliminated as their corresponding teams are. By retaining the most players through the final round, I have the best chance of winning the title.)

So I’ve been staying up late watching hockey and counting my points. Thanks to J.’s wise selections, Annie’s Agitators is currently second, neck and neck with Jesse’s Water Wings. J. lags well behind, having chosen an inferior team for herself. (I take credit for my success, despite J.’s doing all the heavy lifting.)

But, let’s not forget the compounding role of factor 2C: Jelly, never an avid hockey fan, sleeps through long evenings of our rooting for the underdogs. She startled awake once to J.’s raucous cheering after a goal, but the rest of the time she has slept soundly through our deriding the referees. Jelly would never manage to awaken with the birds if she stayed up with us to watch. Perhaps I should follow her lead?

Basset hound Jelly sleeping in awkward twisted position

 

A simple recipe for poisoning your loved one

Picture of pasta with cheese and pepper

Two years ago, J. celebrated her birthday in the ER, where I had gone to seek urgent medical attention. I made the one day of the year that’s supposed to be all about J. all about me. After spending several hours ignoring my symptoms, I could no longer deny their seriousness.

I’ve since succeeded in avoiding hospital visits on J.’s birthday. Last year I left my cancer at home and celebrated J’s birthday in her favourite London pub. This year, staying healthy was a piece of (birthday) cake, for me at least. I have been the picture of health for a chronically ill person.

J.’s birthday this past Saturday started out like any other day. I had carefully planned a special meal for her. I chose not to tell J. what was on the menu so she wouldn’t try to simplify the offerings.

I then carefully gathered my provisions. On Friday, I made sausage and bean soup because soup always tastes better on the second day. I planned to make the pasta and dessert on Saturday.

At dinner, J. enjoyed the soup and the pasta so much that she even took seconds. Then she had her first bite of the Portuguese custard tarts I’d laboured over that afternoon. She left the rest of her tart untouched while I scarfed mine done. She became increasingly quiet, and then she abruptly fled the dinner table.

J.’s using the facilities during a meal is not unusual. Her kidneys are so healthy that she pees hourly. I found it odd when she did not returning promptly to the table, however. I waited and waited, and then I went in search of her, only to discover she had spent the last 20 minutes ridding herself of my carefully cooked dinner. She was so sick that night that she couldn’t even watch her beloved Oilers clinch Round 1.

Ever the catastrophizer, I was sure my special meal had poisoned her. I reviewed the meal ad nauseum. I was sure I’d cooked the sausage meat properly. Yes, I’d adequately heated and then cooled the soup. I’d baked the custard tarts, with their six egg yolks, long enough. And then I considered the fresh pasta. Was there salmonella instead of semolina in the flour mix? (Recalled flour is all the rage lately, but E. coli are the offending bacteria.)

The cheese did have a bit of mold on it, which I cut off before grating, but did I miss a spot? How dangerous is moldy cheese anyway? Turns out some molds are fine–Brie cheese is made with mold, for example–but others molds can make you sick. Then I learned that some molds have a toxin that is precursor to liver cancer. Oh great, I gave J. cancer on her birthday.

Before you throw out all your cheese like I did, consider this: people don’t react to food poisoning as quickly as J. did, according to my wise neuroscientist friend. And despite my questionable immune functioning, I didn’t get sick. Perhaps it wasn’t my cooking after all.

Once I’d determined I hadn’t killed J., J. told me that she’d been feeling off all day. Sorry to hear that, honey, and please excuse my huge sigh of relief.

 

P.S. Turf that green cottage cheese pronto.

 

 

Crisis chez Dr. Liverpaté

Did I mention that, with a little cajoling, I scored myself an appointment with Dr. Foie Gras (who my dear friend insists on calling Dr. Liverpaté, which does have a certain ring to it)? So off J. and I went this week to visit the dear doctor, seeking help for my progressing lumpy gout.

Dr. LP well tolerated our barrage of intrusive personal questions. At our last visit, he disclosed he had married and bought a house. This time, we learned he and his wife recently had their first child, a baby boy. Dr. LP happened to have a newborn picture or two on his phone, which he showed us readily. We oohed and ahhed appropriately.

The doctor’s recent sleep deprivation did not seem to interfere with his clinical acumen. But before we give this esteemed physician too much credit, let’s consider his job: gastrointestinal specialists train intensively for years in order to be able to ask people about their poop. Yes, all such doctors have a morbid interest in their patients’ potty habits, and they make a whack of cash investigating such habits. Can you imagine talking to each and every patient about their No. 2? I certainly cannot, and I am grateful that my clinical interviews cover a broader range of subjects.

And so, after I addressed my concerns, including whether my gouty bumps would continue to grow until they became grossly disfiguring and burst through my skin (we’ll address his response to my catastrophizing some other day), Dr. LP circled back to the No. 2 (not his but mine). But because even a poop specialist prefers visuals to words during a discussion of this type, Dr. LP began looking frantically around his assessment room for the hanging poop chart, a.k.a., the Bristol Poop Stool Scale. Lo and behold, there was none.

With any other patient, this would have been a true GI crisis. Dr. LP knew that I, a longstanding clinic patient, familiar with poop-preoccupied physicians, would know not only about the existence of this chart but also have the chart memorized. I didn’t need the visual reminder; the verbal cuing would suffice. So we had a quick discussion, after which I expect Dr. LP made a note to hang a copy of this chart forthwith so other less experienced patients would not have to endure such an awkward conversation.

Before we left, Dr. LP, who is by nature a serious fellow, displayed an uncharacteristic playfulness, possibly prompted by his recent sleep deprivation. We had been discussing a certain over-the-counter medication, and Dr. LP was distracted by its absurd advertising, which he tried to locate for us. He explained that this medication’s packaging has always been an emasculating pink, so the company had recently come out with a blue-bottled version for macho men. The contents of the pink and blue bottles are absolutely identical; only the colours of the labels differs.

What, then, would I like you to take from today’s post? With any GI specialist, you can expect the poop talk. Hopefully there will be a poster to help you through it. Also, not only do men have babies, they are babies.

 

Blue bottle of Lax-a-Day for men

Dangers lurk everywhere, and other trite updates

Before we get into my bad behaviour on Saturday night, let’s start this week with a few important updates. I’m not ready yet to acknowledge my stupidity so let’s ease into this true confession, okay?

Alfalfa sprouts picture with red RECALL written over itFirst off, I removed the alfalfa sprouts topping my eggs benny yesterday, but proceeded to eat the potentially deadly soft-poached eggs. Sprouts can kill. Does ridding my meal of one potential germ carrier counterbalance not ridding it of another? I didn’t really think so either.

Second, my taxes are ready to be dropped at the accountant’s office later today. I too am in shock.

Several pieces of sugarless gum strewn on a blue tableThird, every time I pop a piece of sugarless gum in my mouth, which is rare these days, I remind myself that I cannot go swimming because my urine will be traceable in the pool. Not that I pee in the pool. Not that I even swim in public pools anymore, although I used to at one time. Sometimes I start thinking of how much pool water I probably swallowed over the years and I get a little queasy. I doubt I’ll ever set foot in a pool again, so perhaps I can stop fretting about my sugarless-gum consumption.

Fourth, and with acknowledgement of my idiocy, I was feeling especially froggy on the weekend. My gout-related bumps (tophi) are slowly growing. I am developing one on the end of a finger, the first to cause me some discomfort. What if my painful lump interferes with my ability to type my blog? Only Saddy truly understands how upsetting this would be.

Instead of dealing with this problem by calling Dr. Foie Gras, my go-to doctor for such issues, I performed an internet search. I wondered what would happen if my body continued to overproduce uric acid, collections of which cause these little lumps. A uric-acid-reducing medication may have contributed to my near-fatal liver failure four years ago, so I’ve been forbidden from taking any since. I’m hoping there are other options.

Scared person looking at computerLet’s not even talk about what I learned on those highly reputable internet health sites. I don’t want to upset you or to haunt you since, for all I know, you too may cross bridges before they’re even built. What I read was not nearly as upsetting as the accompanying photographs. I happened upon a photo of a gruesome tophi-ridden hand likely belonging to the Wicked Witch of the West. It was truly grotesque. (I will spare you by not reproducing that image here. You needn’t be traumatized like I was.)

So not only did I look on the internet for health information, I did it right before bed when I was absolutely pooped. What was I thinking? I needn’t solicit material to inspire nightmares right before bed. Needless to say, my fifth update of note is that my long-vanquished insomnia returned that night. Better not to sleep than to risk a nightmare, I say.

Today, I will be contacting Dr. Foie Gras’s office to see if I might schedule a visit. Hopefully his administrative assistant, who is prone to ignoring my desperate pleas for help, will contact me promptly with an appointment time. If not, I will follow up by sending a copy of that photograph to her. That’ll light a fire under her, for sure.

My salty little secret

Every Monday from 3 to 6 p.m., I volunteer at Canadian Blood Services. As I’ve already mentioned, this volunteer position is so complex I can’t believe they hired me. I am expected to serve soup, cookies, and drinks to blood donors, thank them for their donation, and watch that they don’t fall ill. Sure, there’s some juice and cookie restocking and occasional dish washing, but it’s a pretty lame position that I have mastered handily, except for my soup ladling, which could use work. I’m always dripping everywhere, despite my best efforts.

I chose my shift to keep myself awake once weekly during my usual rest hour. If I’m not napping at that time, I’m eating to keep myself awake. (Bad habit, I know.) It takes all my energy to get to the clinic some days, but once I’m there, I stay awake through my shift. I’m in trouble if I forget to take a snack along with me, though, since the generous pickings are slim for my liver-compromised body.

Donors need to replenish their fluids and one of the best ways to do so, other than taking in liquid, is to eat foods that are sweet or salty. That’s why the clinic stocks canned soup and salty crackers, as well as an endless variety of cookies. Because I am still trying to reduce my sugar consumption, I do not fall down the slippery cookie-laden slope. I’m focussed on the end goal here, so steering clear of sugar is no biggie.

That leaves the salty options, including the soup sodium bomb. As a child who walked home for lunch every day, I often ate canned soup to warm up in the winter. Since I’ve had to monitor my sodium, I’ve scorned anyone who indulges in canned soup, mostly out of envy. I miss canned soup and wish they made it for sodium restricters like me. Ah, the nostalgia I feel at the thought of eating soup from a can.

The past few weeks, I’ve become so hungry (or is it tired?) during my bloody shift that I’ve ladled a very small amount of soup, maybe a few tablespoons’ worth, into a cup and eaten it, relishing every drop. I feel like I’m committing a sin before God every time I do it. The guilt is overwhelming. I can’t help but hear His disapproving voice, “Hey there, pufferfish, yeah I’m talking to you, what’s the point of reducing your sugar consumption if you’re going to increase your salt intake?” Is it rude to tell God to mind His own business?

So far my favourite indulgence has been the vegetable soup, with the mushy vegetables and the tiny letter-shaped noodles. Today I caught myself searching for copycat recipes on the internet. I may have to make one or two or seven to try to replicate this little can of mushy sustenance, but I’m sure whatever I make won’t will taste nearly as good as the real thing since I’ll be leaving out the salt. At least God won’t chide me when I eat it.

Bowl of Campbell's vegetable soup

Not all desserts are just.

Since J. so quickly jumped off the flossing wagon, I’ve been thinking about how hard it is to change bad habits or foster new ones without the support of the people around you. We might not even have dental floss in the house were I not a recently reformed flosser, and I’ve silently encouraged J.’s new habit by modelling appropriate flossing behaviour every night before I brush my teeth. Similarly, some people need a workout buddy to get to the gym–being accountable to that other person motivates them to show up.

Bad habits are no different. If all your friends like to go for a drink after work and you are trying to abstain, you may find it hard to socialize with them at the bar initially because the setting may trigger your urge to drink. If you want to give up smoking, and your spouse continues to smoke in front of you and to keep cigarettes readily available in the house, you might be more likely to relapse.

Let’s consider my Great Sugar Revolution, which will soon be entering its seventh miraculous week. I’m sure I would have had a much harder time eating less sugar were J. to share my sweet tooth and to indulge in excessive dessert consumption in front of me, but she is not. She was not born with the genetic predisposition to sweets that I was. Hence giving up dessert was not that huge a shift for her as for me. She was never one to overconsume chocolate or other sugar-laden treats.

Potato chips on white backgroundSince J. didn’t feel she was making that great a sacrifice by reducing her sugar consumption, she decided, to even the score, that she’d give up potato chips. I didn’t ask her to give up anything since I don’t care what she eats. Furthermore, an open bag of chips in the house poses no threat to me. My sodium-fearing persona keeps all chip urges at bay.

J. seemed to be managing well without her potato chips, although she may have been consuming her contraband out of the house and I’d never have known. Occasionally I’d text her from the grocery store to ask her if she’d like me to pick up a bag of her favourites when it was on sale, but she’d decline. I’d respect her wishes since I’m not one to sabotage J.’s efforts to make what she views as a positive change.

Imagine my surprise when, one evening last week, J. pulled out a mystery bag of chips from the cupboard, opened it, and poured herself a bowl. I was shocked beyond belief. J. is a diligent and determined woman and she follows through with whatever she sets her mind to, flossing aside.

I gently asked her what happened to her resolve. J.’s response, with her tail between her legs, in the most pathetic of voices: “I am weak.”

How did I feel when I witnessed her regression? I was relieved. At least she’s human, fumbling along like the rest of us. Sometimes I forget that.

 

What it’s like to be in Cancer Limboland

Various random signs pointing "This way"

I was having coffee with my dear friend Dr. Mike awhile back. He brought my attention to research on the emotional challenges of people who had survived a bout with cancer. Imagine going through the upheaval of intensive treatment and then having the whole kerfuffle end with surgery or the last radiation or chemotherapy treatment, just like that. This ending should be a time of celebration, but for many people it’s not. Of course they are forever changed by their experience, and they may suffer from the aftereffects of treatment for months or years or forever. Even without a lingering physical impact, anyone can still feel lost post cancer.

I get that, even though I’m still undergoing treatment. Can I call myself a survivor? Is “chronic cancer patient” a better descriptor? I don’t get a day off taking my chemotherapy pills until I die. Dying might not be for a while, if Dr. Bloody Resident was correct, and if my liver keeps living. Did I mention Dr. Foie Gras noted in his recent procedure report that my esophagus may look even a bit better than when he last took a look? I may have some time yet.

Dr. Mike astutely observed that I’m in a weird place right now, suspended somewhere between living and dying. Rational Annie realizes this state of limbo is a gift that I never thought I’d receive. I imagine if my body keeps on ticking as well as it is currently, Dr. Blood will suggest longer spans between appointments, and with that fewer blood tests and other intrusive investigations. I anticipate Dr. F.G.’s doing the same. Consider me to be in maintenance mode, until something shifts. That’s the ominous part, knowing that something could shift. I imagine this unsettled feeling is quite similar to the real cancer survivor’s worries that the cancer could recur.

I need to get my head around being in this strange place where I’m a fairly healthy person with leukemia. Sure, I’m covered in bruises, and infections are easy to come by, but these are minor inconveniences. Now if I could just skip those leukemia-decimating pills, which I take first thing every morning, I could almost forget I have cancer at all.

Keeping busier (volunteer work, and maybe even a new client this week!) seems to help me somewhat–I’ve always felt better when I’ve had less time to sit around and stew. But the leukemia is always on my mind.

Even if I manage not to think about the illness, cancer is everywhere around me. I’m reading a novel where one character dies of ovarian cancer. I wasn’t expecting that. Cancer rears its ugly head in the media all the time. I can’t even watch hockey (not that I like to watch hockey) because of the players’ cheesy Movember moustaches. It seems like cancer is inescapable these days, at least to me.

I may have to go into hiding. No watching television or reading the news, no more novels unless I can be assured there’s no cancer subplot. But don’t worry, you can always reach me on my cell. If I respond inappropriately to your emojis, however, it’s because my phone lacks my finesse at interpreting your feelings.