Saturday, March 18, 2017

Kicking cancer's ass

"Kicking cancer's ass." I'm sure most of you have heard the expression. After Cara was diagnosed, people would talk about how she was going to "kick cancer's ass." It's kind of a weird expression. As if cancer is some sentient being, and as if simply by fighting hard enough, someone with cancer can defeat it.

Of course, that's not true. Cara didn't die because she didn't fight hard enough. How hard you fight has very little to do with whether or not cancer will kill you. (Which isn't to say that how hard Cara fought was not a very beautiful and meaningful thing. It was! It will continue to inspire me for the rest of my life.) Cara died because of simple biology. Out-of-control Darwinian evolution of a small mass of cells in her body that eventually spread to become something much larger and more destructive. For reasons we are not near fully understanding, the response to treatment of those malignant cells, even those that we've identified through the tremendous, decades-long work of countless scientists and doctors as having the same driver mutations, varies widely from person to person. Some people have much better luck than Cara did. It's not because she didn't fight as hard to "kick cancer's ass."

I've also seen people use the expression when they talk about participating in charity events (especially those involving strenuous athletic pursuits) to raise money for the struggle against cancer. Events like the Pan Ohio Hope Ride, a four-day, 328-mile bike ride to raise money for the American Cancer Society. 

The Pan Ohio Hope Ride's Facebook profile picture - a picture of my dear friend Shelli Snyder!

Another such charity event (although one requiring much less exertion on the part of its participants) that is very near and dear to my heart is Breathe Deep Cleveland, a 5k fun run and walk to benefit lung cancer awareness and research funding that Cara founded before she passed away.

These events are great. The battle against cancer is one in which we need all the help we can get. Every dollar raised has the potential to positively affect someone's life.

We've come a long, long way in our understanding of this horrible disease. We know vastly more about the underlying biology than we did a hundred, fifty, or even (especially when it comes to certain specific genetic abnormalities) ten years ago. This helps us devise better treatments. It also helps us better understand the underlying causes - why people get cancer in the first place. There's a whole lot we still don't know, but we've made great strides in the fight against cancer.

Sadly, today, in this country, there is a concerted effort underway to reverse much of that progress.

Republicans in Congress are trying to pass the "American Health Care Act" - their replacement for the Affordable Care Act. The Congressional Budget Office has estimated that this act would result in a whopping 24 million Americans losing health insurance compared to current law. Don't trust that number? Think it's "fake news"? The White House estimated an even bigger loss - 26 million.

It's pretty simple - if you get cancer, and you have health insurance, your odds are going to be a lot better than if you don't. If you can afford medical treatment, your outcomes will tend to be better than if you can't. If Cara didn't have health insurance when she was diagnosed, she would have died a lot sooner. The same is true for many terminal cancer patients. And there are many other cancer patients who have had their lives saved by medical treatments. If the AHCA passes, there are going to be a lot more people who have to make the horrifying choice between bankrupting their families or giving up on their treatments.

There's more.

The White House recently released their budget proposal, which cuts funding to most of the government programs that are vital in our shared efforts to (I have to say it) Make America Great. Two items in particular are especially relevant to the fight against cancer. A nearly 20% cut is proposed in the budget to the NIH, which provides an enormous amount of the funding for medical research in this country.

Without NIH-funded research efforts, I can say without any doubt that Cara would have died much sooner after her cancer diagnosis than she did. It was because I saw firsthand the benefits of cancer research that I decided to enter the field myself after obtaining my PhD in Biology.

The other highly pertinent and disturbing item in the proposed budget?  A greater than 30% cut to the EPA.

That is something that should horrify everyone who breathes air and drinks water.

(That is, everyone. Duh.)

Although there's still a lot we don't understand, we've come a long way in our knowledge of what causes people to get cancer. Probably the most widely recognized such causative link is that between cigarette smoking and lung cancer. Of course, it's not a one-to-one link; Cara didn't smoke. But we all know that years of smoking increase the chances someone will get cancer. That's because the toxins in cigarette smoke damage DNA in cells and make it more likely that those cells' genetic programs will go awry and lead to uncontrolled malignant growth.

Cigarette smoke is far from the only toxin that can do such damage.

In China, rates of lung (and other) cancer have skyrocketed. This is a direct result of rapid industrialization without the protections the EPA affords us here leading to a dramatic increase in pollution. In less than a decade, rates of lung cancer in Beijing rose more than fifty percent. We've all seen the images of the horrendously smoggy Chinese capital city.

Without government-mandated environmental protections, things would look much the same in major American cities.

But surely, you might say, even with a 30% cut to the EPA, we won't let things get that bad here. And that might be true. Still, it's a simple equation. More exposure to environmental toxins = higher rates of cancer. That's just a fact.

In the war between humanity and cancer, Donald Trump has staked his position firmly on the pro-cancer side. And any Republican elected officials who support these budgetary and health care proposals have likewise staked their positions just as firmly on the pro-cancer side.

Doing charity events like the Pan Ohio Hope Ride and Breathe Deep Cleveland is great. We have a good time with friends and we raise money for a good cause. But as much as that makes us feel good about ourselves, the sad reality is that Donald Trump and the Republican Party are setting out to do far more harm in the fight to save people's lives from cancer than all the good that will be done by all of the participants in all of those charity events.

Right now, if we want to kick cancer's ass, we have to kick Donald Trump's ass.

Monday, February 20, 2017

This is the last time. Are you sad?

Last summer, I started a series of posts about the online word game Psychobabble in which Cara and I met, and that, as our friendship grew, we increasingly used to flirt with each other via sentences we made in the game.

First Psychobbable post (Note: this post includes an explanation of how the game worked. Since it's been so long since my previous post on the topic, it's probably worth including a very brief refresher here. The game was based on magnetic fridge poetry, and in each round, players in a room of up to twelve had one minute to pick some words from a set of around 60-70 tiles and arrange them into a sentence. Then all the sentences were displayed and players voted for their favorites.)

Second Psychobabble post

I intended it to be a three-part series, and now I'm finally getting around to writing the third part, which covers July and August 2006 including the first trip we ever took together, an event that was shortly followed by the end of the game Psychobabble. As before, I'll be posting screenshots of sentences, sometimes with corresponding in-game chat, along with my explanations of the sentences. And as I said in the previous post, "I will remind everyone again that she and I never collaborated on sentence making; every single time that we made sentences that went with each other it was a case of us being on the same mental wavelength by thinking of the same inside jokes or, in certain cases, by some bizarre coincidence."

Now, back to the sentences.

July 9
As shown in my previous post, we really liked to make sentences about going on walks together.

July 10
"Fishing" - as in fishing for compliments from each other - was something we often accused each other of, and made jokes about, in our online chats.

July 11
Cara and I decided that we were going to travel together to Washington, D.C. in early August to see a show by our favorite band, Ozma. This sentence by Cara celebrates our decision to go!

July 13
Cara's sentence was foreshadowing of numerous future walks on which we would hold each other's hands. My sentence is a reference to the fact that I had recently sent her a short video clip of me playing the piano (specifically, a snippet of the Ozma song "Gameover").

July 23
Here we both made sentences referencing the fact that Cara worked at a company called Garden City Group.

Our two sentences both referencing the Ozma song "You Know the Story" go together nicely.

July 29
Cara's sentence is about the fact that she liked a lot of the music I listened to. My sentence teasingly insinuates that Cara liked music we considered bad such as "In the End" by Linkin Park and "My Immortal" by Evanescence.

August 1
My sentence here kind of amazes me. As I talked about in my previous blog posts about Psychobabble, it's one that could plausibly be "just a sentence," but I have no doubt that in my mind when I made it was the fact that I had never been on a real date (something I had not directly told Cara!) and that if Cara and I went out on a date she would therefore be "my first date." Which did, of course, happen, but not until a little over three months after I made this sentence!

August 2
And here's one from Cara that could be "just a sentence" but was undoubtedly actually about her hopes that I did in fact "like her" (as more than a friend).

This was shortly before our trip to D.C. My sentence is obviously about the fact we were going to a show there. Although we were going primarily so that we could see Ozma, they were actually not headlining the show but rather opening for The Rentals (another band we liked), so that's what Cara's sentence is about.

"Speedy speed boy" is something Cara had called me in reference to my being a runner.

August 4
After we returned from D.C., we learned the dismaying news that Popcap, the company that ran Psychobabble, had announced they would soon be shutting the game down. My sentence is about this, with a classic Garden Fight reference. I should also mention that of the two people who voted for my sentence, one was (of course) Cara, and the other was... Cara's mother! But I didn't know that at the time. Actually, a while before Cara had told me that her mother played Psychobabble, but I thought Cara was joking, and when it became clear I thought she was joking, Cara decided to play it off as if she had been joking rather than continue to try to convince me. It wasn't until years later that I learned the truth.

Just days before we went to D.C., I broke my arm after falling down while running, which meant that Cara had to do all the driving on the trip. Here's Cara with a rather cruel (and hilarious!) sentence about my injury.

Another sentence by Cara about her hopes that I was into her.

A great sentence by Cara about the imminent demise of our favorite pastime.

August 7
While on our trip, we saw a sign for "Forks of Cheat," a winery in Morgantown, West Virginia. We thought this name was very funny. I love Cara's sentence referencing it.

Cara's sentence is about the fact that we had slept in the same hotel room in D.C. (but in different beds!).

August 8
In retrospect, my sentence is kind of cruel considering how apparent it was Cara had a crush on me and how uncertain she was of whether I felt the same way about her! Good thing it ended up not being Cara's imagination! Her sentence is a reference to the bowling outing that was the first time we got together in person.

One of the highlights of the trip was the fact that in the car, I read aloud to Cara Cretaceous Park, the sequel to Jurassic Park that my best childhood friend and I wrote in fifth grade. (In August 2015 I created an annotated version of Cretaceous Park and it can be found in this blog post.) This led to a lot of laughter on both our parts. The funniest thing to us was the absurd repetition of the phrase '"Run!" shouted Alan.'

Because I had a broken arm, it was hard for me to open a bottle of water. Cara's sentence is a great reference to this, evoking a scene of her watching me struggle with the bottle and waiting for me to ask for help (she did end up helping me open the bottle). My sentence comes from the fact that certain aspects of our trip were very poorly planned, mainly that we did not pick a dinner location ahead of time, assuming we'd come across something, and then (in those pre-smart-phone days) failing to do so after walking around the National Mall for a while and then taking the Metro to near the 9:30 Club, the concert venue. We were both very hungry, me especially. I ended up buying a bag of chips at a gas station across the street from the 9:30 Club. In the fall of 2015, on a trip in which I went to a concert at another venue in the same area, I discovered that there were actually numerous restaurants just blocks away from where we had been. Oops!

Cara's sentence is another reference to her helping me open my water bottle. My sentence is another reference to Cretaceous Park. 

August 9
Here's another Forks of Cheat reference.

While at my parents' house, I was looking at Cara's pictures from the trip on Flickr, and my mom saw that the name on the Flickr account was Communista, leading my mom to say, "Is... is this person a communist?" (Cara was not a communist.)

I really like this pair of sentences referencing the Ozma song title "Light Years Will Burn."

Aw, what a nice sentence by Cara.

Cara with another Rentals sentence. Me with another "is it flirting or is it just a sentence" sentence.

While I made a sentence about our D.C. trip and Cara made a sentence about hoping to go to another show with me, Jen (SA_shedevil) also made a sentence about Cara and me. She was someone who frequently played Psychobabble with us and who Cara had privately told about her feelings for me. I'm pretty sure I voted for "Your walks are really more than that" thinking that it was Cara's sentence and I don't remember what I thought of it when I saw it was actually Jen's sentence.

I feel like with the game soon ending, Cara was feeling desperate and was making more and more sentences hinting at her feelings for me. Although we did flirt some in our frequent AOL Instant Messenger chats, we were much more flirtatious in our Psychobabble sentences, because there was the plausible deniability factor of "maybe they're just sentences." The game going away would remove this outlet. It makes me wonder if things would have played out any differently, and perhaps sooner, had the game not gone away. My sentence, by the way, is about Cara driving the car on our trip while I controlled the music from the passenger seat.

Cara's sentence references the fact that we took the Green Line on the D.C. Metro. My sentence is a twisted reference, but one that Cara nonetheless got (and loved!), to a rest stop on the way to D.C. that overlooked the Youghiogheny River. (I combined the tiles "Yugo," "-ing," and "-ly" to make something that very vaguely resembled Youghiogheny.) This would be a good place to quote the first paragraph of Cara's wedding vows:
Even before we met, we finished each other's sentences. After we had actually met, I knew I wanted to get to know you better. And as we sat atop a hill overlooking the Youghiogheny River later that year, I knew that I was beginning to fall in love with you.
(Well, I have tears in my eyes now.)

August 10 - the last day of Psychobabble

Awwwww. Cara was going all out on the flirting.

My punny and topical sentence here was very popular.

These are my and Cara's final Psychobabble sentences ever, which we made in the same round. Very fitting.

Despite our incessant flirting in the game, it wasn't until almost three months later, November 4, that we finally revealed our feelings for each other and started dating. The long delay was partly due to the fact that after that trip to D.C., we did not see each other in person for over two months. This next in-person get together was for an Okkervil River concert in Columbus, after which I finally came to the full realization that I did want to give being more than friends with Cara a shot. And the time after that when we saw each other was that fateful November 4, Cara's first of many trips to see me in Cleveland.

Psychobabble was gone forever, but in the months and years to come there were multiple attempts at recreating it by fans of the original game. The best was called Pseudobabble, which we would enjoy playing many times over the years, all the way up to as recently as 2013. Sadly, Pseudobabble eventually died off, and to my knowledge there is no working Psychobabble-like game online today.

It really was amazing the way Cara and I hit it off after meeting through this game and then the way we used the game to create our own unique way of communicating with each other. What a fantastic love story...

Sunday, January 29, 2017

Tender Warriors strive to...

Tenders Warriors
find the courage to be sensitive
 be emotionally vulnerable
be comfortable with & embrace solitude
never compromise their integrity
 be true 
be kind
practice self-acceptance & self-love
give an honest effort
be present
be patient 
be transparent
- Tender Warriors Club manifesto (by Lady Lamb aka Aly Spaltro)

I had a very busy concertgoing end of the week as I saw three shows in two nights. Lady Lamb, touring in support of her new Tender Warriors Club EP, was the second of the three. I think all three shows are worth writing about.

First, on Thursday night, I saw local indie rock band Cloud Nothings play to a sold-out Beachland Ballroom. Going to see Cloud Nothings play at the Beachland was something that had a sort of eerie significance for me. The last time I did that, also on a Thursday night, was on August 22, 2013. That was the night before the day that Cara was admitted to the hospital, leading to her being diagnosed with lung cancer. As I wrote in a blog entry on the three year anniversary of that occasion, "I had a really great time at that Cloud Nothings show, which some of my friends also attended. Looking back, that was the last time that my life was anything resembling normal." So that was certainly on my mind.

As usual, I had great fun seeing Cloud Nothings. Something I've realized at their shows is that I really enjoy a good mosh pit. Moshing, however, is something that almost never occurs at shows by any other band I see regularly, so it's something to look forward to when going to see Cloud Nothings. It's funny, because I remember the first time I encountered a real mosh pit at a show, which was the Ozma reunion show at the Knitting Factory in Hollywood in March 2006. It was too rough for me and I quickly retreated to a less wild part of the crowd. Now I'm 33 years old and may even have been the oldest person in the pit on Thursday, but there's just something really exhilarating about bouncing around and off of other bodies in a mass of unpredictably moving human beings, in time to loud rock music! One of my friends remarked on how I had been in the pit for almost the entire show while he had only joined in for the last song (the always amazingly intense extended version of "Wasted Days" that Cloud Nothings usually close their shows with), and I replied, "It makes me feel alive!" I was going for a laugh but there was a lot of truth in my statement.

Friday night brought two shows, both by supremely talented female singer-songwriters. First was Lady Lamb (formerly known as Lady Lamb the Beekeeper) on her "Living Room Tour," a series of intimate, solo acoustic performances. The show was not actually in someone's living room but rather in a back room at the Canopy Collective art gallery, a cool setting nonetheless. This was my third time seeing Lady Lamb and each show has been a very memorable occasion.

The first time, March 29, 2014, I braved a heavy snowstorm to head out to the Beachland Ballroom and see a really spectacular show at which Lady Lamb opened for Typhoon, easily one of the best combinations of two artists at one show that I've ever experienced. In fact, Typhoon's White Lighter and Lady Lamb's Ripely Pine are my top two favorite albums of the year 2013. Also very significant in retrospect was the fact that the first opening artist was the band Wild Ones, a fact that would lead me at another Wild Ones show to having a great conversation about Typhoon and about Cara with Wild Ones' lead singer Danielle Sullivan, who unbeknownst to me at the time was engaged (now married) to Typhoon's lead singer Kyle Morton!

The second time I saw Lady Lamb was at the Grog Shop on July 26, 2015. This was the day after Cara's grandmother Margie passed away, which itself was three months and one day after Cara passed away. Margie was also one of my very favorite people, and in a way her death kind of felt like "Cara's death, part two," so naturally both their losses were heavy on my mind that night as Lady Lamb put on a really amazing performance. Her song "Ten" beautifully concludes with the line, "There's a sweetness in us that lives long past the dust on our eyes once our eyes finally close." And wow, did that hit me in the feels that night.

The show on Friday was a big departure from my previous Lady Lamb concert experiences, because her music normally rocks a lot harder than you'd expect for someone described as a "singer-songwriter." It was great to hear these new takes on some of her songs, and the stripped-down acoustic performances really allowed one to take in her lyrics, which I think are some of the best out there today. She also brings an incredibly expressive voice to the table, one that can quickly go from delicate to full of raw emotion. Aly had two acoustic guitars and a banjo with her, which she switched between and repeatedly tuned in between songs. She said that the change in weather was bad for the instruments and blamed a visit to Florida earlier in the tour. She had a lot of great interaction with the crowd amidst a fantastic selection of songs that included a number of requests.

Before playing the final song of the night (the haunting "We Are Nobody Else" from her new EP), Aly gave a little speech in which she explained how Tender Warriors Club was more than an album to her. She explained how one day she had been talking to a friend on the phone, a friend who was going through a really difficult time and who had spontaneously decided to take a trip to Paris, and she had told her friend that her friend was a "tender warrior." At the time she said it, the phrase didn't have any special significance to Aly, but then it stayed in her head and she started to think about it more and more and it become a sort of life philosophy that is summarized by the "manifesto" (from her website) quoted at the beginning of this post. She said that this had become especially important to her in light of all the scary things going on in the world right now. I was very moved by her words. I thought about all the struggles in my own life, and I thought about Cara and Margie, and when Aly said that she would be at the merch table right after the show and would love to talk to people, I decided I wanted to tell her the story about seeing her the day after Margie died.

After she concluded her speech and before she started playing the last song, I glanced at my phone to check the time, and naturally (because both Margie and Cara, aka Margie's "favorite birthday present", were born on September 22) it was 9:22 pm.

At the conclusion of the show a long line of people formed at the merch table. Fortunately, I had been near the back of the audience and was able to get a spot early in line. When it was my turn to talk to Aly I complimented her on the great performance and then I told her that what she had said about "tender warriors" was very beautiful. I then said that I would like to tell her a little story, and I told her that my wife had died of lung cancer in April 2015, and three months later my wife's grandmother had died, and the day after that was the previous most recent time I had seen Aly perform. And that the line about "There's a sweetness in us that lives long past the dust..." had made me think of my wife and her grandmother.

As is usually true when I tell a musician something like this, she seemed very genuinely appreciative. As I've said before, if an artist (or anyone else) does something that has a real and meaningful impact on your life, and you get an opportunity to tell them, you should take that opportunity! (And now that I think about it, I suppose that's part of being a "tender warrior.")

I went on to tell Aly that music was one of the things that helped me get through hard times in my life. She replied, "Music is one of the only things that helps me."

After I'd finished talking to Aly (as well as buying a record and t-shirt), it was off to the CODA music venue in Tremont for the second show of my Friday evening. There I went to see a local band that has become one of my favorites, Noon. Noon started out as a solo project of Erin Kapferer, who plays the piano and sings. She has since added guitarist Patrick Stefan and cellist Shelby Sangdahl (who is quite a busy performer, contributing to a number of projects including the wonderful Shawn and Shelby and who also played with opening artist Sol Fox on Friday).

I first encountered Noon at the Heights Music Hop in October 2015, a little less than half a year after Cara's death. The music of Noon has also been good to turn to in difficult times. For the combination of being both very sad and very beautiful, it's hard to beat. Noon's first album, 9 Years, was just Erin and her voice and piano. It's a wonderful album. The addition of cello and guitar rounds out Erin's sound really nicely, and most of the songs performed on Friday were from a new album the trio are working on now. I'm looking forward to it a lot. After the show, I went up to Erin to tell her it had been a great show as usual. I guess she's noticed I go to see her a lot because she said I was her "super-fan." (Aww!)

There is a lot of scary news right now. So hooray for great music, and hooray for tender warriors!

Wednesday, January 25, 2017

Make America Great

As we all know, Donald Trump campaigned on a promise to "Make America Great Again."

Exactly what was meant by the phrase was left fairly vague, but clearly the slogan implies this: at some point in the past America was a great nation, but today that is no longer true.

This, I think, would be news to all the members of the LGBT community who have, under President Obama, finally received the basic human rights they had previously been denied. Or to the countless citizens of this country with debilitating health conditions who are finally able to get the care they need thanks to the Affordable Care Act. Or to all the women and minorities who have been, at best, second-class citizens for most of this country's history. Okay, let's be honest - for all of this country's history, but to a significantly lesser extent in recent years than for the previous two-plus centuries.

There's an argument that, in actuality, America was never great. It's based on the undeniably true premise that our nation was built on a foundation of slavery and genocide. And the argument goes that, for the whole history of the USA up through the present, forces of discrimination and oppression have been so integral to this country that it could never truly be called a great nation.

Of course, all nations have checkered pasts, and presents. One could argue that there is no such thing as a great nation. There are, though, a lot of genuinely very good things about the United States of America. Among them, this nation has long been considered the leader of the free world, and there are legitimate reasons to call it that.

Sadly, with the ascension of Donald Trump to the presidency, that claim must be (temporarily, one hopes) abandoned. No nation whose chief executive kowtows to the brutal dictator of Russia can be called "leader of the free world."

For a long time, the right wing in this country has liked to bandy about accusations of Democrats being un-American, for reasons such as opposition to President Bush's disastrous Iraq war. These accusations have almost always been unfounded. In perhaps the most ironic example yet, Bill O'Reilly said that efforts to delegitimize Trump's presidency "border on sedition."

Donald Trump rose to prominence in the modern Republican Party thanks to a completely baseless and shamelessly racist attack on the legitimacy of Barack Obama's presidency.

Today, for the first time in living memory, accusations of one's political opponents being un-American are perfectly justified: Donald Trump, as evidenced by (among other things) his sucking up to Vladimir Putin and his attitude toward the First Amendment, is un-American, and so are other elected officials too spineless to stand up against Trump.

Although it feels like beating a dead horse, I'd like to list a few of the other more egregious examples of why it's a national disgrace that Donald Trump is our president:

Trump broke from a decades long bipartisan tradition by refusing to release his tax returns. We already know that Trump has massive conflicts of interest (a fact that should set off alarm bells by itself), but without his tax returns, we have no way of knowing the full extent of those conflicts. Furthermore, Trump's only real claim to being qualified for the presidency was that he is supposedly a successful businessman - but without records of his finances, it's impossible to know whether Trump, who came into wealth via his father, can even be legitimately described as a successful businessman.

Trump has a long history of unabashed racism. One of the most obvious examples is when he said that American-born Judge Gonzalo Curiel was not qualified to rule on the Trump University fraud trial because of Curiel's Mexican heritage. Republican Speaker of the House Paul Ryan even had to admit what Trump said was the "textbook example of a racist comment."

Trump is almost undoubtedly a serial sexual assaulter. He was caught on tape bragging about committing sexual assault, and then over a dozen women came forward to corroborate what Trump had said, with some of the women having their claims corroborated by still other people. So there's basically no reason to doubt Trump is guilty of this heinous crime. By electing him in spite of this, our country essentially re-victimized millions upon millions of sexual assault survivors who have to live with that trauma every day, and also sent the message loud and clear to potential future perpetrators of sexual assault that they'll be able to get away with it. This is absolutely horrific and disgusting.

Any one of those things alone should by itself be reason enough to disqualify Trump from the presidency. I doubt that any die-hard Trump supporters are reading this, but I'd love to hear an argument why these are not utterly shameful behaviors and why it is okay to support someone who has done these things for the presidency. (I did get into a little Facebook argument shortly before the election with someone who said that the timing of the sexual assault accusations was suspicious and therefore the women should not be believed, oh and also that because in the tape Trump said women let him do it, that meant what Trump described was not sexual assault. Also, that the women's claims would have been believable if they had gone to the police immediately after the incidents. Vomit. Please educate yourself on how society and the legal system treat sexual assault victims, and stop putting forth arguments that perpetuate rape culture.)

Now that Trump has taken office, the depressing news seems to arrive by the minute. One of the most disturbing items is the Trump administration's putting forth the idea of "alternative facts."  First over something as trivial as inauguration crowd sizes, but it's undoubtedly a sign of things to come, and it's a classic tactic of fascist governments straight out of 1984.

The one thing giving me hope is the knowledge that Trump and his supporters are clearly a minority in the country. The massive turnout for the Women's March on Saturday was a striking statement of this. Unfortunately, we have a broken political system that has allowed a party with support from a minority of voters to take complete control of our government. Trump lost by millions of votes nationwide but is now our president. At the same time, gerrymandering of House districts and the vastly disproportionate power given to residents of small states in the Senate have massively stacked the deck against the Democratic Party in Congress. Add to this Republican voter suppression efforts, which are only going to get worse in the years to come (Trump's repeated and blatant lie about millions of illegal votes being cast in the election is a clear signal of this), and the idea that we live in a representative democracy is becoming more and more of a fantasy. This should be disturbing to anyone regardless of their political views.

Donald Trump and the Republicans in Congress are a rogue political force taking advantage of a broken system to push forward a deeply unpopular agenda that will harm almost everyone in this country other than the very wealthy. The way I see it, there are two potential outcomes to this situation that are both quite plausible. One potential outcome is that Trump will serve as a wake up call to the populace, spurring a new era of political activism and a massive resistance movement that will do the best it can to mitigate the damage over the next four years, and then seize the reins and start moving things toward a brighter future. Another potential outcome is that Trump and the Republicans in Congress will largely get their way and America will go into a sad decline from which we won't truly recover for decades, if ever.

The fight to make America great is on, and whether you believe we'd be making America great again, or making America great for the first time, it's a fight that can only be won if we all stand up and do our parts to resist Donald Trump and his cronies. And that includes those of you who have normally voted Republican in the past and are now ashamed and disgusted by what Donald Trump is doing to your party and to our country. You have to hold your Republican elected officials' feet to the fire, and if those officials don't stand up against Trump's abuses, as much as it might pain you you have to turn out for Democratic candidates in 2018 and 2020. (I myself find much to complain about with the Democratic Party, but we have a two-party system and that's not something that's going to change in the immediate future.)

This isn't a right vs. left partisan battle. It's a battle between fascism and anti-fascism. One of the great things America has done in the past is resisting the forces of fascism. And now we have to do it again.

Saturday, December 31, 2016

Jeff's search for meaning (or, the year that was)

I recently met and became friends with a 29-year-old widow. It's been a really good thing. As another widow friend of mine (someone significantly older than me but still quite young to have become widowed) said, it's great to talk to someone who "gets it."

After we had talked for a while, my new friend told me that my approach to life made her think of a book called Man's Search For Meaning. I decided to read the book, and after doing so found myself quite flattered that she had said that. Man's Search For Meaning was written by psychiatrist Viktor Frankl, a survivor of Holocaust concentration camps. The first half of the book tells of his experiences in the camps, while the second half lays out his formulation of logotherapy, an approach to psychotherapy based on the idea that the most important desire of humans is not to seek pleasure, but to find meaning in life (the form that this meaning takes can vary from person to person). Frankl wrote of how some people in the camps were able to persevere the horrors that surrounded them by finding meaning in their existence. For some, simply enduring suffering could provide meaning.

A brief aside: writings about the Holocaust seem distressingly timely right now.

I realized that, although I had not previously thought of it in such terms, a lot of what I do in how I choose to live my life, and perhaps especially in my writing, is an attempt to make sure that the lives of both Cara and myself have been and will continue to be meaningful.

Another friend posted today on Facebook asking if people had a blog and if so, "What does having a blog do for you?" With the book I had recently read in mind, I replied, "Helps me search for meaning in this very strange, terrible and wonderful thing called life." (Being honest, I added, "Also, gratification from people complimenting my writing.")

I have always had a strong interest in staying in touch with the history of my life. This interest was strengthened by Cara's death, but it was there long before that. My mom has told me, "You save everything," commenting on the fact that I have a drawer full of things I wrote or made when I was in elementary and middle school and that I also have basically every computer file of mine that I've created since the early '90s. As I've written before, it is a really wonderful thing for me that among those computer files are included all the electronic conversations Cara and I had from when we were first getting to know each other (a time at which the vast majority of our conversations were electronic in nature) all the way up to the last weeks of her life.

The world is a scary place right now, and it seems that this has strengthened even more my desire to connect with the past. When I was at my parents' house for Christmas, I went for a walk around Grandview Heights, the suburb of Columbus in which I grew up. This is something I've done many times over the years, but on this particular walk something was different. I had this strong urge to connect with my childhood in a way that I had never felt before. I went to McKinley Field, where I played youth baseball while in elementary school. I sat for a moment on the bench in the dugout, then walked out onto the field. I stood in the batter's box. I stood on the pitcher's mound. I ran around the bases. All the while I was trying to conjure up memories of doing those same things some 25 years ago. Later in the walk, I went by my old schools. From kindergarten through twelfth grade, all of my schooling happened within the same city block (very conveniently located just a half-mile or so from my parents' house). Kindergarten and first grade were in a little building called the "Annex" located across the playground from the building that housed the elementary and middle schools.

When I was in kindergarten and first grade, that playground was not there; instead, there was a street that now dead-ends on either side of the playground. Those changes had been made by the time I got through middle school. I know this because I have a specific memory from a recess on that playground during middle school. There was a kid, a football player, who liked to bully me and would often try to steal my lunch bag. One time he had my lunch bag and I (at least as skinny back then as I am today) charged across the playground and knocked him to the ground. We both got in trouble (an extreme rarity for me!) and had to sit down on a curb next to the playground for the rest of that recess. More changes have occurred since then. The Annex is no longer used to hold classes, and the elementary/middle school building is now entirely a middle school with the elementary school on the other side of town.

Anyway, although I've walked past those buildings countless times over the years, I can't remember ever before feeling the urge to look into the classroom in which I attended kindergarten. But on this walk, something drew me to that little building, and I peered in through the window into the depths of my past.

The truth is, I retain very few specific, episodic memories from when I was in kindergarten. They've mostly faded away with time. But I very much remember being in that room. The sight of it was a very familiar one.

The reality that the little boy who sat in that classroom some 28 years ago would become the person peering through that window some 28 years later, and in fact is the same person but separated and molded by that passage of time, is so surreal for me to ponder.

Why was I so drawn to those spots from my childhood - my old ballfield, my old school buildings - on this particular visit to my hometown? I'm pretty sure it's because the world today feels like a totally different place than it did just two months ago. And not in a good way. So I cling even more tightly to the past, nostalgically yearning for the happy innocence of my youth. Yet knowing I can never have it back.

The election of Donald Trump to the presidency is without a doubt one of the worst things that has ever happened in my life. The fact that he was selected by only a minority of voters softens the blow a little bit, but the fact that someone who is an open and unapologetic racist and misogynist, and a serial sexual predator (and, let's not forget, completely unqualified for the job), could be elected the leader of the most powerful country in the world is absolutely horrifying. And yes, some will say, people voted for Trump for other reasons, in spite of his racism and misogyny, not because of it.

That doesn't make it okay.

If you're willing to overlook how your candidate utterly dehumanizes vast sections of the population, that's not a whole lot better than being openly supportive of that dehumanization.

And let's not be naive. There are a lot of people - I won't try to estimate what percentage, but a lot - who were drawn to Trump in large part because of the racism and sexism.

As 2016 draws to a close, it's become a cliche to remark on how horrible a year it was. Trump's election being a large part of that, but for many other reasons as well. So it's kind of funny for me, while fully recognizing and acknowledging the reasons that 2016 was horrible, to realize that 2016 - on a personal level - was overall one of the best years of my entire life. Why?

Fittingly for New Year's Eve, I'll count down the top ten reasons.

10. I got to spend a lot of great time with friends and family, and made a lot of new friends along the way!

9. I was adopted by this very crazy but very adorable little fellow!

Gavroche joins my two lady kitties Eponine and Mitters, and I'm very glad to have all three in my household. I especially cherish all the time I have with Mitters, who was Cara's cat long before I knew Cara, and who will be 19 years old in less than two months.

8. I took up a new hobby in mountain biking and totally fell in love with it! Riding the trails is something I'm missing a lot during these winter months.

7. I've greatly enjoyed playing pickup basketball at the fitness center at work, and over the course of the year I've gone from being pretty good at rebounding but pretty bad at everything else to being able to hold my own in most aspects of the game (while still being best known as a ferocious rebounder - opposing players who are guarding me and aren't familiar with my game are often warned by their teammates, "You have to box him out.").

6. I had a really wonderful family vacation in the Adirondacks, and best of all, I finally climbed the highest peak there, Mt. Marcy, something I'd hoped to someday do for most of my life. It was probably my favorite hike ever!

5. I also had an amazing time visiting my aunt Jeri and cousins Chelsea and Calyn in California! It was especially great that I got to spend so much time with Chelsea and, despite us having spent very little time together in the past (they are actually blood relatives to Cara, not to me, and plus they live across the country), it instantly felt like Chelsea and I had been great friends our whole lives! And I also got to meet my online friend Deana, a lovely person who first befriended Cara through the online lung cancer social media community.

4. Anyone who knows me knows that going to concerts is a huge part of my life, and 2016 was undoubtedly the best year for concerts of my whole life! Some of the top highlights were Florence + the Machine, Temple of the Dog, Daughter, Explosions in the Sky, Okkervil River, Nada Surf, Lucius, Bruce Springsteen, and Madi Diaz, and there were so many other great shows too!

3. The Cleveland Cavaliers won the NBA championship after coming back from a 3-1 deficit to the greatest regular season team of all time in the Finals, ending Cleveland's 52-year title drought in one of the most dramatic events in sports history, and I was in downtown Cleveland with my good friend Fiona when it happened! One of the best days of my life!

2. Shelli Snyder is still with us and is making great strides in her long road to recovery.

Enough said.

Well, I guess I should add that the events surrounding Shelli's crash are another example of how good things can follow from a tragedy. Just as I learned so much about life from watching my wife live with and then die from cancer, I made and strengthened many friendships and was drawn much more into the wonderful Cleveland cycling community by that horrible incident some three months ago in Montana.

And the top reason why 2016 was a good year for me...

1. The first three months of the year were pretty bad for me. Quite bad, in fact. For the reasons why, feel free to refer to this post from last December. But then things began to improve. Improve a lot. Don't get me wrong, I'm not pain-free and probably never will be, but for the majority of the year I've been at a point where chronic pain is not preventing me from enjoying life. There have been plenty of other times in all my years with chronic pain that that has also been true, but this is the first time ever that my seeking out of health care actually directly led to an improvement in my condition, rather than it failing to help and then things eventually changing for reasons that often seemed largely random. As a consequence, I feel more in control of my life than I have at any point in more than a decade!

There are a lot of good reasons for the world at large to look at 2016 as a bad year, but the sad reality is that there's a good chance things are going to get a lot worse, and in the future we'll look back on 2016 nostalgically. Whether or not this is true, it's important for us to always cherish the good things we do have, and the friends and family who play such a large part in making life worth living.

One way to find meaning in life is to work to make the world a better place. That's something you can find meaning in whether or not that work is successful. Unfortunately, there are times when we have to work really hard simply to try to prevent things from getting worse. Now is one such time. There are a lot of scary things on the horizon. One ties directly to my number one reason that 2016 was good. I was able to receive health care that resulted in my life going from basically terrible to pretty darn good. Being able to receive needed health care is so, so important and is something that should be denied to no one in any prosperous society. We have made a lot of progress in expanding access to health care, and although there are still enormous flaws in our health care system, more people have access to health care now than ever before.

Efforts are underway to reverse that. Because Republicans in Congress value giving bigger tax breaks to Donald Trump literally over people's lives. We all have to do everything we can to stop that from happening.

Happy New Year, everyone.

Thursday, December 1, 2016


As it is for me, writing was an important part of Cara's life. She kept a number of different blogs over the years. The last of these was Mets SUCK! (The story of a girl with metastatic lung cancer.) Prior to that was A Girl About Cleveland, a blog that Cara started shortly after she moved to Cleveland in 2008 (having decided that if our relationship was going to continue to progress, it could no longer be a long-distance one) and that mostly focused on food but also contained various tidbits about Cara's life in her new city.

On November 24, 2013, Cara posted on her Girl About Cleveland blog for the first time in over half a year, a post that would be the final one on that blog, titled simply Thankful. She wrote:
This summer started out wonderfully. I logged over 1000 miles on my bicycle and had great fun with friends and family. At the end of August however, I was diagnosed with ALK+ adenocarcinoma of the lung. Needless to say, that has kept me busy. I spent a week in the hospital after diagnosis and ended up going back about two weeks later for a related medical complication (for another week). 
Treatment is going well though, and my prognosis actually looks good. As we approach Thanksgiving, I truly have a lot to be thankful for. I may not be at 100% healthwise, but I'm here and all things considered...I feel pretty good. I am surrounded by friends and family who care tremendously for me, and I'm in the capable hands of the staff at one of Cleveland's best cancer hospitals. 
I have so many stories to tell all of you - even though chemotherapy has changed my palate and appetite some, I've been able to eat and drink some amazing things. I'm hoping to get a blog or two under my belt during the holidays (no Black Friday shopping for me!) so I can tell you all about them. 
I wanted to share a recipe that Cleveland's own Chris Hodgson posted on Dim and Den Sum's Facebook page back in November 2011. This cranberry sauce is the perfect combination of tart, sweet and spiced. It's a hit with my family. Make enough to share (and enough to put on your turkey sandwiches in the days following Thanksgiving)!
(She finished the post with the cranberry sauce recipe.)

Before continuing this story, I want to pause for a moment to point out that Cara was completely incorrect when she wrote, "my prognosis actually looks good." And I knew that she was incorrect. However, no one told her this, and it's an interesting ethical question.

You see, when we got the results of the genetic testing showing that Cara's lung adenocarcinoma was ALK-positive, Cara's doctor explained that this was good news, because it opened up more treatment options. There was a drug called crizotinib (brand name Xalkori) that had been developed in recent years to specifically target ALK-positive tumors, and for patients who had such tumors the response rate with crizotinib was much better than with traditional chemotherapy. When Cara wrote that post, she had been taking crizotinib for a little over two months, and was responding well based on how she was feeling and on her most recent scans. Therefore, she felt that her prognosis looked good.

Being a scientist, I had naturally looked up research articles about crizotinib, and had seen that, in the clinical trial, the median progression-free survival was about 8 months longer with crizotinib than with traditional chemotherapy. This meant that the typical outcome for someone taking crizotinib was that they would gain about 8 months in which their disease would be under control, but ultimately they would still die of lung cancer.

There is no cure for stage IV lung cancer. The hope was that the progression of research generating new treatments would outpace the progression of Cara's disease, so that her disease would continue to be controlled and perhaps, some day in the future, a novel treatment would come about that could completely eradicate it. Or that could turn it into a chronic condition that would not actually progress to lethality. This hope was not a totally unrealistic one. There are people who have been able, thanks to the development of new treatments, to live much, much longer with the disease than Cara did, some who are still alive and well more than a decade after diagnosis. Still, the most likely outcome was always that Cara would succumb to her disease.

Cara's doctor did not explain this. In fact, Cara's doctors never told Cara that she should expect to die of cancer until the last week of her life. Should she have been told? I don't really know the answer to that question. I lean toward thinking that in Cara's case, it was better not to directly tell her. I think it was good for her, and for me, that she had that optimism, and could try to live life as normally as possible. Of course, even if she had been told, "You're probably going to die of this," that's not the same as, "You're definitely going to die of this," and Cara would likely have been just as determined to beat those odds. Don't get me wrong, she was well aware that she had a life-threatening condition, just not fully aware of how the odds were stacked against her. I knew all along that Cara would probably die of cancer, but I still hoped that she wouldn't. I never told Cara that she would probably die of cancer. The first time I ever heard her express the sentiment herself wasn't until 2015 when she told her mother, as the three of us sat in a doctor's office, "You know, this is probably going to kill me some day," and as it turned out, "some day" would arrive just a few weeks later.

Returning to November 2013. The very next day after Cara posted her "Thankful" post, she messaged me from work to say, "Ugh. This cold weather sucks. My chest just aches!" She later told me one of her online friends was urging her to call the doctor, leading to this exchange:
Jeff McManus
It's still bad? 
Cara McManus
It sort of feels like someone's sitting on my chest 
Jeff McManus
That sounds unpleasant. 
Cara McManus
It kind of is.
I'm breathing okay but there's a definite weight on my chest
Feng isn't at Seidman today
So I don't know what I'd do.
I'm kind of worried but I don't want to be a complainer
I'm raspy and stuff 
Jeff McManus
Well, it wouldn't hurt to call. 
Cara McManus
Kinda busy right now
I mean, I don't have the time to have a conversation with a doctor right now
Am kinda concerned though
And still later that afternoon:
Cara McManus
I am really hoping this chest pain gets better. It is making me nervous. 
Jeff McManus
I hope so too! 
Cara McManus
It seriously feels like i'm missing half of my lung
This was something that happened several times during Cara's illness - Cara being reluctant to go to the doctor about serious symptoms she was experiencing because she didn't "want to be a complainer." I don't say this to be critical of my late wife, but it's an interesting insight into the mindset she had. The next morning when she was feeling no better I convinced her to call the doctor, which led to her being admitted to the hospital, and it turned out to be a very good thing that she didn't wait much longer because if she had there's a chance she could have died way back then.

When Cara was in the ER, this exchange occurred:
Jeff McManus
What have they told you? 
Cara McManus
I stopped responding to Xalkori 
Jeff McManus
Well, that's not what I wanted to hear :( 
Cara McManus
You and me both
Haven't talked to Feng since she first came in though
I assume i'll do the other drug
I hate that doctor in the ER 
Jeff McManus
Why's that? 
Cara McManus
I don't feel like typing that much
I'll tell you when I see you
The reason that Cara told me she hated that doctor in the ER was that an ER doctor, someone who had no relationship with Cara and had never seen her before, had offered Cara the completely unsolicited opinion that there was no shame in considering hospice care. Needless to say, this was extremely upsetting to Cara, especially since when it happened she was alone in the ER, with no family or friends present. Cara's doctor (Dr. Feng) was also extremely upset at hearing of this incident. That conversation, if it were to come up, would be one for Cara's personal doctor to have with Cara. An ER doctor who did not know Cara had no place bringing it up. And that doctor had no idea about the different treatment options that Cara might have available. It would have been a terrible mistake to go to hospice care at that point in time, and I shudder to think how someone in a similar position but without Cara's strength of will or her strong support system might have taken that advice.

Cara was certainly in a grave state health-wise. We learned that that feeling of a weight on her chest was due to the fact that her pericardium, the sac that contains the heart, had filled up with 800 milliliters of fluid. That's a lot. (In September, after she had been diagnosed but before she started taking crizotinib, a similar incident had occurred when Cara's breathing worsened fairly rapidly over a couple days and after admission to the hospital we learned she had a whopping three liters of fluid in her chest cavity - but the pericardium is a much smaller space, so this time the situation may have been even more urgent.) She would have to have surgery to drain the fluid and to create a pericardial window - a hole in the pericardium so that additional fluid would not be stuck there. The surgery was scheduled for December 2. I don't remember all the details of that week or why it was exactly that the surgery was a week after Cara was admitted, but I'm sure there were good reasons. So while waiting for that surgery to take place, we spent Thanksgiving not in Columbus as we normally did, but in the ICU at University Hospitals in Cleveland.

Cara's parents came up from Columbus to spend Thanksgiving with us. At my and Cara's apartment, the three of us (her father Trent doing the majority of the cooking) prepared a Thanksgiving dinner to take to the hospital. I personally made the same applesauce that I have made for family Thanksgivings for many years, as well as the cranberry sauce that Cara had posted the recipe for on her blog and had made in the past. Making that cranberry sauce has become my thing as well - I've done it every year since, including 2014, when Cara was well enough that she made rolls and a dessert for our family gathering. It's a really delicious recipe.

Having Thanksgiving in the ICU was definitely not what we wanted, Cara most of all. But it was good that we still had a Thanksgiving, and good that Cara's parents could join us. The day after Thanksgiving was the last Friday of the month, meaning it was the day of the monthly Critical Mass bike ride, and Critical Mass rode to the hospital in honor of Cara.

The location of her room did not allow us to see them, but Cara was so moved that her friends did this for her. "Happy tears tonight. Cleveland Critical Mass FOREVER. All of you give me so much hope," she posted on Facebook.

The following day Cara was able to be moved out of the ICU and to a room in Seidman Cancer Center, which was very good because she hated being in the ICU.

There are several conversations over the course of the almost two weeks Cara ended up staying in the hospital that stick with me. I don't remember the exact order in which they occurred. I do know the first was with Dr. Feng. I was very worried about the fact that Cara's condition had worsened so dramatically in such a short period of time. She told me that sometimes when cancer became resistant to a treatment like crizotinib, there was a sort of rebound effect resulting in rapid progression. I asked her what the next step would be. She told me that she hoped to enroll Cara in a clinical trial for a newer ALK inhibitor drug, alectinib.

I was very stressed out and feeling very distraught throughout that first week. I remember going to the pharmacy at Target to pick up a prescription. I remember hoping that a young pharmacy tech named Ally who Cara and I had met recently would be there. The way we met Ally was quite remarkable. While picking up a prescription for blood-thinner medication, Ally asked Cara, if she didn't mind telling, why she had to take that drug. Cara explained why, and we were startled to learn that Ally's fiancé (now husband, and yes, he is still alive and well) Matt had been diagnosed two years prior with the exact same stage IV ALK-positive lung cancer! It was such a remarkable coincidence. We shared our experiences with each other, and learned that Matt had been on death's door at diagnosis but had made a remarkable recovery after taking the same drug crizotinib that Cara was on. That drug had saved his life. That story was one of the main things that gave me hope.

I told Ally about what was going on and she could tell I was very upset. I told her how Dr. Feng had brought up the alectinib trial, but the fact that Cara had failed crizotinib so quickly made me worry that the same would happen. Ally told me that she and Matt knew of some people for whom alectinib had worked more effectively and for a longer time than had crizotinib. "Cara is going to get better. That clinical trial is going to work," she told me. "It has to, it just has to."

This made me feel slightly better. Slightly.

On the day of Cara's surgery, Cara's mother Joyce, Cara's aunt Jean, my mom, and I were all gathered in the waiting area. After the surgery, the surgeon came out to us and told us that the surgery had been successful, but based on what he had seen when he was in there (and he did point out to us that he was not an expert), things did not look good.

I'm pretty sure my immediate response was a sardonic smile, like, oh, of course.

During the course of Cara's illness, there were three main low points for me. The first was the time of her diagnosis. The third was the end of her life. This was the second.

After the surgeon was gone, Joyce said something about she wished he had given some sort of time table. Of course, he wasn't really the one who would be able to do so. But we were all given the clear impression that Cara probably didn't have much time left. Perhaps a few months, I remember thinking.

Late that afternoon, I posted a terse status update on Cara's Facebook account:
This is Jeff. Cara got out of surgery about 1:00. The procedure to put in a pericardial window was successful. She is in the recovery room now, still waiting until she is ready to be moved to a hospital room.
I remember sitting across from my mom in the cafe at the hotel across the street from the cancer center, and telling her that, although I had known that there was a good chance that Cara would not survive her illness, I had not expected things to go downhill so soon and so rapidly.

I also remember sitting next to Cara after she was back to a hospital room. I smiled at her. She told me that I looked much more at ease than I had before the surgery. The truth of it was that before the surgery I was so worried about what might happen, but now I was already coming to terms with the notion of her dying.

My mom and I agreed that Cara should be informed of what the surgeon had told us. It was hard to tell Cara, though. Eventually I decided that the best way to inform her of the bad news would be to ask the surgeon to come see Cara and tell her basically just what he had told us, in the same clinical way. Then she could react however she felt like reacting, rather than having my own grief over the words influence her reaction.

So he did come to her room and tell her. To my surprise, Cara seemed unfazed by the news. Like what he was telling her wasn't that big a deal. Perhaps the drugs she was on helped. Her attitude was basically, it is what it is, and now we're going to move on to the next thing.

There was some concern over whether Cara was healthy enough to be accepted into the clinical trial. On December 6, she signed the consent form.

On  December 12, she was officially accepted, and she started the trial the very next day.

When we spent that Thanksgiving in the ICU, I fully expected that it was Cara's last Thanksgiving. Even at Christmas the following month, I thought it was probably Cara's last Christmas. But over the next few months, Cara made the most amazing improvement. By spring she was even able to get back on her bicycle and do some long rides. And not only did alectinib work better against Cara's cancer than any of the other treatments she took during her twenty-month battle, it also had the least side effects. For a little while, in April and May, it was like Cara was almost back to her normal self!

It couldn't last forever, though. In late May we found out that there were some small metastases in Cara's brain and she had to stop the trial. She went through several other treatments over the next almost-year; they all helped temporarily but none worked as well as alectinib. (Alectinib, by the way, has been FDA approved and is now helping lots of lung cancer patients, and they all owe a debt of gratitude to Cara and everyone else who participated in that clinical trial.) Still, through all of that time Cara and I were able to enjoy so many great experiences together. It wasn't until the very last week of her life, in April 2015, that her health and ability to function returned to the low point they had been at in the week of Thanksgiving 2013. None of that would ever have happened without the heroic efforts of numerous doctors and research scientists who made Cara's treatments a reality. So, just like Cara was when she wrote that last post on her Girl About Cleveland blog, I am truly thankful.