This will be the final post

At 2:00am on October 2nd, 2016 Naomi Beth Sichler died peacefully at home surrounded by her family.

We were both always floored at the effect this little public notepad could have on others, and have been overwhelmed with the support we received over the years. We always wondered why people were so interested in the way we lived our lives together, when to us, we were just trying to enjoy each other.

I have so many thank you’s to deliver due to the expansive amount of help and love we have received, that I am bound to miss a few, but know that we could not have loved each other and lived so richly had it not been for the help of so many. Naomi always reminded me that people seemed to run towards us, not away, when they found out about her diagnosis. In this way we were lucky, unfortunately, this is not always the case.

First off, thank you to Skirball Hospice for providing some of the finest care imaginable during this time. Your professionalism and compassion instilled confidence and peace. The constant calls and texts from nurses not even on duty, shows how much you all truly care. Your presence during our time of need allowed, and even made possible, a beautiful end to Naomi’s journey with us.

Thank you Compassion & Choices for being such strong advocates for the terminally ill. Although Naomi chose not to take the aid-in-dying medication, the relief it brought her to know it was an option is something all terminally ill patients should be able to feel.

Thank you to our team at UCLA. Despite Naomi being a USC Trojan, she didn’t trust anyone else with her care. Dr. Nghiemphu, Nanette, Tom, and Cheryl, you all made us feel that you cared about us as people, not just patients.

Thank you to everyone who came out of the woodwork to show us support in the form of cards, flowers, clothes and blankets, rides to doctor’s appointments, food deliveries, and apartments to stay in for family members from out of town. This list is larger than the internet, but thank you all.

To my family – Thank you for accepting Naomi as a daughter and sister. She got unfathomable joy from knowing her family had doubled. Thank you for helping us enjoy the small moments in life through cards, books, and many other actions that let us know you were thinking of us. Thank you for instilling my sense of family, compassion, humility, and caring that helped me provide Naomi with strength when it was needed.

Thank you to Naomi’s family. Eleanor, John, and Tim my heart goes out to you. You were the fortunate ones who knew Naomi the longest. Thank you for raising and supporting the most authentic, strong, loving and thoughtful woman I ever met. Eleanor – Thank you from every inch of my soul for putting your life on hold on numerous occasions to help us maneuver our way through this disease. Thank you for your positivity. Thank you for supporting me as well over all these years. The expansiveness of your love knows no bounds. John – Thank you for being such a steady presence at all times. I know Naomi’s calmness in the face of adversity came from you. Tim – Thank you for your unflinching loyalty, friendship, and comfort to not only Naomi but to me. You and Naomi were always looking out for each other and shared a relationship that she treasured like none other. I am truly blessed to have you all in my life. Knowing that Naomi’s blood runs through you brings me much needed solace.

Thank you to our friends. Vast barely describes this list and the amount of thank you’s to include here so I’ll keep things general. Your words and actions have left me astonished, and floored as to how we could be so lucky to have such amazing people in our lives. Thank you all for helping us have a good life worth living. We are forever thankful for your generosity, loyalty, shoulders to cry on, hands to hold, firm hugs, smiles shared, heartbreaks comforted, and celebrations together. I have no doubt we will carry on Naomi’s legacy together.

Lastly, thank you Naomi, for pouring your soul into this blog and into our relationship. Your openness and authenticity shined through in all that you did. Thank you for getting the broom out and helping me sweep up the pieces of my shattered life. Thank you for taking a chance with me and milking every ounce of love out of our all-too-brief time together. Thank you for pushing me to be a better person; the best version of me. Thank you for being fearless and honest. You have made an irreversible impression on my being. Every step I take in this life will be made with you. I am left with a void the size of the universe in my heart, but I thank you for bringing such amazing people into my life to help me grow around that void. Thank you for bringing me way more than net-joy. I love you.

We are all Naomi’s brain,

Mike

Memorial Service Details

Anyone who has been impacted by Naomi’s journey is welcome to attend a memorial service celebrating her life.

Date: October 30, 2016

Time: 12-3pm

Location: Ahmenson Senior Center at Expo Park

Parking: There is limited free parking on S. Park Dr, but many available lot and metered spots on the streets surrounding the center (Bill Robertson Ln and Martin Luther King Jr. Blvd).

Donations: If you would like to send a gift or condolences, here are two organizations that provided us guidance and information that was paramount in our navigation of this disease.

Simms/Mann Center for Integrated Oncology

Cancer Support Community – Benjamin Center

Permission to Feel

As some of you know, I pitched a version of this essay to The New York Times’ Modern Love editors, but they unfortunately passed. I couldn’t think of a better day than today – Mike’s and my second (and final) wedding anniversary – to share this piece of my heart with you all. Not everyone is fortunate enough to find true love during their time on this earth. We are two of the lucky ones who did. And this is our story.

Permission to Feel

a chapter closed

Well, that’s another chapter closed. Last visit to my oncologist: check.  img_1913(Yes, I made sure to rep my alma mater for this final foray into enemy territory.)

We completed the POLST form, which instructs the paramedics not to resuscitate me should they happen to be called for any reason during this final stretch. I haven’t come this far down the path toward dying peacefully at home to end up with broken ribs and full of tubes in an ambulance/ER/ICU. I also completed the paperwork for the EOLOA, including a final visit alone with my oncologist, a requirement of the law that helps ensure patients are not being coerced into requesting the aid-in-dying prescription. Mike will be able to pick up the actual medication this week. It’s a huge relief to have that process completed, as it takes more effort to get out of the house each time.

We also bid a tearful goodbye to the nurse practitioner who has helped me navigate the nasty side effects of cancer treatment for all these years, and to my oncologist, who has patiently answered my endless questions and helped me grapple with some of the most difficult decisions of my life. I never felt rushed out of her clinic and that gift of time and attention is something I’ll be forever grateful for. We didn’t get everything right, and there are some things I’d personally do differently if I had it to do over again, but we each did our best. I know she cares about me and has always respected my autonomy as a patient and a human. In a world with no perfect answers or crystal balls, you can’t do much better than that.

This weekend, we got a bit of respite at our friends’ house in Pasadena. (Huge thanks to the Merendino/Williams family once again for their generous hospitality!)

Chelsea joined us up there for the weekend (and Lauren popped in for an afternoon), and we just hung out, relaxed, and soaked in the breathtaking views. We even got to watch the fireworks display after the  UCLA game at the Rose Bowl Saturday!

My most frequently asked question is how I am feeling. Answer: 

Physically, I’m tired and can feel my energy waning. My neck and shoulders are in pain and I’m having trouble getting comfortable/out of pain whether I’m awake or asleep. The nausea I’d been experiencing over the past couple of weeks seems to have abated somewhat, but my food aversion is still pretty strong.

Otherwise, I’m:

  • Relieved to be definitively done with treatment and the decision-making struggles that entails.
  • In mourning about all I’ll miss: Christmases by the fireplace, dinners with friends, camping trips, game nights, tailgates, weddings, birthdays, births. A lifetime of memories I won’t get to make.
  • Awed by the love Mike and I have shared over these years and heartbroken that it’s coming to an end. 
  • Filled with gratitude that I have a husband, family and friends who are doing all they can to make these final weeks as comfortable as possible for me. (Mike has stopped working for the time being, and we are soaking in these moments together, many of which include me dozing in bed and him reading quietly next to me, or softly recounting some of his favorite memories from our years together.)

status update 7/6/16

Lots of people have been asking how I’m doing since my Avastin infusion last week. I’m hanging in there. I don’t really feel any differently since the infusion but haven’t been sleeping well so have been pretty fatigued. Today is my last day on the 4mg dose of steroids. Hoping the reduction to 2mg tomorrow will make a big difference in my sleep and other side effects. The swelling and water weight I’m carrying around with me are getting really uncomfortable, another reason I’m very eager to start the process of tapering the steroids. 

Mike estimates based on his look at the MRI that my tumor grew by about third since my scan six weeks ago, so things are progressing fairly rapidly. My left-arm weakness is significantly worse. Typing and writing have become very difficult. Looks like Siri and I are going to become better friends. I am still working hard on keeping up my strength. I’m doing a series of exercises every day for my legs and back and have recently added arm and hand exercises under Mike’s guidance. I got a Fitbit a couple weeks ago as well, which is helping keep me motivated to move around the house and take my daily walks. I’m pretty sure I am actually getting more steps/activity than when I was working; and it’s a good challenge to find creative ways to stay off the couch. 

I’ve also begun preliminary work for an essay series I plan to develop addressing the patient and family experience within the modern American healthcare system. In the coming weeks, I plan to interview folks who have had cancer or another chronic/terminal illness about their experiences from diagnosis through end-of-life care. This project is the result of a series of conversations with my healthcare providers, Mike, my mom, friends, and others in this regard.

I’ve begun to read some of the literature/consume other media on this topic, including When Breath Becomes Air by Paul Kalanithi, Being Mortal by Atul Gawunde and this fabulous TED talk by BJ Miller, senior director and advocate at Zen Hospice Project, in San Francisco. These physicians are contributing in tremendous ways to the conversation about how the healthcare system needs to and can be transformed to place the patient at the center. I feel that the voices of the patients and families themselves are, in large part, missing from the conversation taking place in the public sphere, however. I hope that through this series I can help shed additional light from this important perspective. 

If you or anyone you know has experienced cancer or another chronic or terminal illness — or is a family member of someone who passed away after receiving care within the healthcare system — please let me know if you would be interested in speaking with me for this project. 

Even as I embark on this project, we’re still trying to squeeze in as many adventures as possible. Our friends Ted and Sara are back from Europe and were in town over the past few days, including the holiday weekend. Huge thanks to Ted for driving me to my various doctor appointments last week. It was great to be able to spend that time together. We also had so much fun with the two of them and our friends Jeff and Ana listening to the sounds of one of our favorite bands, The Dustbowl Revival, at the beautiful Levitt Pavilion in Pasadena this weekend. And we enjoyed a spectacular view of the Rose Bowl fireworks from Ted’s parents’ house in Pasadena. #netjoy

challenges and opportunities

It’s been a bit of a tough week. Mike has been hit especially hard by the news of his grandma being placed on hospice care. Now 87, Grandma Marge has been growing more frail for a few years now. She relocated to South Carolina a couple years ago to be near Pam and Gary and has been unable to bounce back from a series of health issues/events, ranging from stroke to falls to increasingly severe memory problems. Her health has declined quite precipitously in recent weeks, and the family is now focused on ensuring her final days are peaceful and  comfortable. Mike and I have spent some time talking this week about some of his favorite memories of his grandmother. He describes her as the “quintessential grandma” — kind, loving, and a great baker! Our love and thoughts are with Pam and Gary and the rest of Mike’s family during this difficult time. 

Also filed under difficult news: As some of you know, the weakness in my left arm, as well as my overall level of fatigue, have been on the rise for a couple weeks now. We’ve been tweaking my steroid dose to get the symptoms under control. It’s sorta working, but the increase in steroids has, in turn, triggered a mild fungal infection, so we’re treating that, too, and it seems as though we’re reaching the end of the road with the steroids. Their reduced effectiveness and accumulating side effects (facial swelling, water retention, painfully dry, flaky skin, insatiable hunger, muscle atrophy, the list goes on…) have forced a conversation about what comes next. 

I had hoped to have all the pieces of the End-of-Life Option Act (EOLOA) in place prior to considering a switch to Avastin, given the (small: ~1%) chance of serious side effects (stroke, brain bleed, gut bleed, etc.) that could dramatically reduce my quality of life (assuming I remained cognitively intact, of course). However, it’s a several-week process, which requires me to jump through a whole series of important hoops, designed to protect me and ensure I’m not being coerced in any way. So, while we can start the ball rolling on that next week, it seems like we’re going to be making a concurrent switch to Avastin. In fact, my first infusion is scheduled for 11am on June 30, the day after my MRI. This will give us the night to weigh the MRI results and make a final decision before proceeding. 

The good news: If I don’t experience the rare, lethal side effects, I should actually start feeling (even) better once my steroid dose is fully tapered (about a week after the first Avastin infusion). Losing the bloating, fat, and extra water weight and continuing my hard work toward regaining some muscle mass are certainly enticing prospects!

More good news? We’re getting away for the weekend! We are headed to a cute little cottage in Topanga Canyon to continue the birthday celebrations and spend some quality M&N time. We are very much looking forward to the time in nature enjoying each other’s company and setting aside our worries as best as we can for the moment. 

Wishing everyone a moment (or many more!) of joy this weekend, especially Ryan and Shannie, whose wedding celebrations we’re so sad to be missing.

And sharing a little photographic evidence of our own joy last weekend, when a host of amazing friends threw an epic picnic to celebrate our birthdays at an outdoor movie (Indiana Jones and the Last Crusade). What a fun night. Thank you to everyone who came out, and an especially big thanks to our party planners, early gatherers, balloon and cupcake bringers, and chauffeurs!

learning to dance in the rain

Last summer, my dear friend Chelsea made me a paper chain — with one link for each day of radiation treatment. More than just a creative way to mark my progress through treatment, on each piece of the chain Chelsea wrote a meaningful quote by some of her — and my — favorite authors, poets and philosophers. I’ve been revisiting the stack of quotes recently and have found many to be timely and relevant to my present situation.

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The three pictured below, in particular, help capture the peace that found me during our staycation weekend at the Merendino/Williams pad in Pasadena. I find that it’s easy to breeze glibly by quotes like these unless I am intentional about pausing and thinking and allowing them to really reach me.

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I took the time today to sit with each of these three quotes and think about why it felt meaningful to me in the context of this special weekend. Here goes:

It’s not about waiting for the storm to pass. It’s about learning to dance in the rain. 

In the most literal sense, I was hoping for a warm, cloudless weekend that would allow us to take advantage of the pool at the Pasadena house. While the clouds did burn off in the afternoons, it was mostly pretty overcast and chilly. On Sunday morning, when Mike and I paid our friends Eileen and Ned a visit at their new house (affectionately dubbed “The Hobbit Hole”) in La Crescenta, it was actually raining. The misty rain, however, along with hot tea, coffee and oh-so-flaky pastries we picked up at Gio’s in Montrose, were the perfect backdrop against which to be introduced to Eileen and Ned’s quaint mountain cabin. The clouds also provided the perfect weather for sleeping in, napping, and just generally relaxing — something Mike, Tim, Jen and I took full advantage of during the entire weekend.

We must let go of the life we have planned, so we can accept the one that is waiting for us. — Joseph Campbell

Joseph Campbell has been a spirit guide throughout my entire journey with cancer, and these words have resonated with me for many years. This weekend was just another example of the gifts that are waiting when we are able to let go in the struggle to hold on to our hopes and dreams and accept what life is offering instead. In the case of this weekend, it was precious time with Tim and Jen, whom we don’t get to see nearly often enough. Interesting conversations about healthcare and food policy, hilarious stories about the antics, trials and tribulations of Jen’s fourth-grade students, and laughter over our fumbling attempts to deliver prompts in a game of Taboo.

We do not remember the days. We remember the moments.

Here are a few of the moments I’ll remember and treasure from this weekend:

  • Sitting with Mike, Eileen and Ned in The Hobbit Hole eating a crumbly, not-too-sweet, coffee-cake muffin, drinking a ginger hot tea and petting the kitty, Ginger.
  • Taking a sunset walk with Mike on a peaceful dirt path lined by mature trees.
  • Looking out toward the mountains from the patio with Mike and Tim sitting close by.
  • Gazing at Van Gogh’s Portrait of a Peasant during our visit to the Norton Simon Museum.
  • Enjoying a late-night donut meet-up in Eagle Rock with our friends Jeff and Ana.
  • Preparing a simple-but-satisfying meal of grilled kabobs and rice with Mike, Tim and Jen.
  • Lying in bed reading in the late afternoon sun and waking up an hour and a half later from a delicious nap.

We are SO grateful to our friend, Ted, and his parents, Gari and Ellen, for making this little staycation possible for us. It was the perfect location — not too far from home to make the drive uncomfortable for me, but far enough to make it feel like a real holiday-weekend getaway. I’ve loved the Merendino/Williams Pasadena home ever since Ted first introduced me to it in college, and it made for the just the change of scenery I needed to escape from purgatory for the weekend.