Starting the Clinical Trial

On Saturday, October 18, we rolled out of bed at 3:30 AM and made our way to the airport to catch a plane to San Francisco. The travel day was uneventful and long, and I spend the hours grading papers on the plane. We landed at SFO around noon. The day before, we had been told that the UCSF family house had a room for us, which we were relieved to hear. If that didn't work out, we had back ups. A friend of a friend offered us her Airbnb in Inner Richmond and a Girl Scout mom added me to her Hilton friends and family so we could book at a discount. All very nice offers, but really nothing could beat a free stay 3 blocks from the hospital with breakfast and dinners included. They also provided us with a free Uber from the airport to the house. 

The Family House is nice. It is in Mission Bay, a neighborhood that barely existed when I lived in the Bay Area. It is across from a food truck rodeo and putt putt golf course and a block away from a Mission Bay Kids park. There's a neighborhood grocery and lots of coffee shops. Our room was basically a dorm room. There were two twin beds, a fold out recliner/bed, a TV, closet, and bathroom. Not a great set up, but functional enough for the week. We gave my daughter a bed, and then my husband and I took turns sleeping on the fold out chair. 

Across the hall from our room was a communal kitchen with a communal food pantry and fridge. Items for everyone were donated from a local food bank. There was also fresh veggies from a local farm and sourdough bread from a local bakery. Each family staying in that "neighborhood" had individual cabinets and mini fridges where we could store our own items. There were tables, couches, toys, and TVs. The house also had an outdoor patio, music/game room (courtesy of the band Train), and a lending library. We were in and out a lot, but they had therapy pets visit one day, crafts during dinner, and a movie night. 

Most of the families there seemed to keep to their own floors or were in an out for appointments. There were two families on our floor that we talked to. Most families seem to go home on the weekends, but when we got there on Saturday, one family was in the kitchen prepping for their twin's birthday. They were turning 8. The mom and daughter had been at UCSF since May getting treatment and now waiting on a liver transplant. The dad and son moved to the Family House in August because they didn't want to be separated any more. They are from Arizona. Another mom had been there since January waiting on a liver transplant for her son who was about 2 or 3. She lives outside of Sacramento and goes home for the weekends to see her other kids, but comes back to UCSF every week. 

We talked a bit about treatments and diagnosis. It is weird having these discussions because my daughter doesn't look sick. She does not look like one of those kids on the St. Jude's commercials with no hair and pale skin. Outwardly, you would not know that she has cancer. A social worker at the house told my husband that our daughter looks like she is doing really well. She is, and I am hopeful that she will continue doing really well. But, we are also newly diagnosed, and there is a very real possibility that could change quickly. 

Anyway, after getting settled, we ventured across the street to get some dinner from one of the food trucks. Later, my daughter and I walked up to Safeway to get some snacks and breakfast items for the week. The last time I lived in CA, I did not have a kid. Walking around the Safeway on 4th and King where all the train stations meet might have made me a little uncomfortable as a single adult, but it's definitely a different experience when you have a kid with you and someone dressed in an ape costume blasting music from their boom box necklace jumps out at you from one of the aisles. I'm just going to chalk it up to exposing my sheltered, suburban kid to some culture. 

On Sunday, my mother-in-law and her husband took us out to sight see a bit. Before leaving for SF, my daughter said that one of the things she wanted to do was to see the bridge. So, that's where we went. But, I think my daughter, with her short term memory issues, forgot what she told us. The entire time she had the worst attitude. She was rolling her eyes, complaining about being there and being cold, wondering what we were doing, and just generally being a grump. Its like the time change, stress from traveling and impending medical treatments, hunger, and tween attitude all coalesced to turn her into a giant asshole for the day. And we couldn't even see the bridge because of the fog.

To top it off, no one had a plan. I try very hard to not take on that mental labor and stress when it is not my family we are dealing with. But, sometimes it seems that other people, especially ones who don't regularly live with children anymore, don't understand the ticking time bomb that is a hungry, tired, extremely annoyed kid. In this situation, my brain goes: where is the closest place with easy parking where we could get lunch that I KNOW my kid will like. We cannot go wandering around and eventually find somewhere acceptable. We cannot stay in the foggy part of the city because kid is cold. I looked up nearby restaurants on yelp and find a pizza place 10 minutes away in Sausalito (easy parking + sun shine + food she'll probably like). So, that's what we do. After eating and in being in the warmer weather, my kid was slightly less angry. Slightly. She still had to wander around with adults, which she wasn't thrilled about, and hated anything we tried to get her to look at. 

Monday was MRI day. We had just gotten an MRI a few weeks before, but they needed to do another one to get a baseline for their study. It was going to be sedated so they could do brain and spine and do a lumbar puncture. That means nothing to eat or drink after midnight except water and apple juice. The MRI was scheduled for 10:30 AM. Everything went fairly smoothly, except when waking her up from sedation. She hasn't really had any issues waking up before, but this time she was so upset that she did not have sweat pants and had worn jeans instead. She cried trying to get dressed. She was mad getting into the wheelchair and waiting for the shuttle to take us back to the house. Once back at the house, I let her eat as many bowls of Cocoa Puffs as she wanted. 

Tuesday she got an echocardiogram. This is so they can make sure the medications don't have an adverse impact on her heart or liver. Then in the afternoon, we had to go back and meet with the trial team to review the results of all the tests so far and talk about next steps. We had also been having delays getting one of the medications in, so they wanted to make sure we could get them. Everything looked good. Her MRI was stable from the last one, so while there is still some inflammation and activity from her surgery and radiation, it is either unchanged or getting better. 

After the appointments, we ventured on the T-line to Chinatown, another place my daughter really wanted to go. We went into some stores, bought snacks and trinkets, and went to a random restaurant where my kid hated everything. So, to appease the beast, we went to an Italian restaurant in North Beach where the kid got calamari and pasta, and I got a much needed glass of wine. After dinner, the kid was DONE. So, back to the house we went.

Wednesday was a free day with no appointments. My MIL came up to the city again, and we took the T to Union Square. The last item to check off on my kid's SF To Do list was to go to Ghirardelli. I did not want to go all the way back up to the Marina where it would be cold and foggy, so we just went to the store in Union Square. This was good enough. She got a milk shake and was happy. We wandered around a bit and then made our way back to Mission Bay to the kids park where she could play. The SFPD was having a Halloween neighborhood outreach event with bounce houses and trick or treating next to the park, so that helped the kid's mood. She was climbing out of whatever funk she had been in, though to quote her on the phone with her sister: "The bounce house is a little boring, but you would probably like it."

Thursday we officially started the trial medications. She had to get an IV and blood work to get a baseline before starting medicines. Then, she was given ONC201 and trametinib. The only issue she had was some dizziness after taking them, but it went away fairly quickly. We had to stay in the office for about 2 hours for monitoring and to talk to the nurses about taking the medicines and documenting everything. We were given pages and pages of information. After a long morning, we were able to get some lunch before we had to go back for a final blood draw. During that time, I decided we should pack our stuff and get a hotel near the airport for the night because our flight was so early in the morning.  

Once we were all done, we got an Uber to our hotel. As soon as we checked in, it was like the mood shifted. The beds were huge and fluffy. We had air conditioning and privacy. There was a bar. Everyone was happier. We hung out in the hotel's lobby/bar area, playing games, watching football, and eating the food we got delivered from some random restaurant in Burlingame. 

We caught a shuttle at 4 am Friday morning. I was nervous about our first flight to Detroit because we weren't sitting together. We had to book so last minute that there weren't any seats together. A nice lady next to my daughter offered to switch with me without me asking, and everything from there was fine. 

We arrived home around 5 PM and went down to my parent's house to pick up my younger daughter, who was so happy to see us that she was a tiny ball of chaos until we got her into bed that night. That Friday was my birthday, and when we got home, my mom had chili cooking in my crockpot and carrot cake in the fridge. Even after watching a 4-year-old all week, she still wanted to make my life a little easier, which is incredibly kind. We proceeded to stay home, sleep in, and veg out most of the weekend. 

While in SF, we were asked by a few people if we missed CA or what we like about NC. I personally am happy to have lived there, and I am happy to be here now. It's hard to know what kind of community we would have built in CA had we stayed. We were in our 20s, and people in their 20s kind of suck when it comes to support. While it's possible we could have built solid connections, most of the people we knew there have moved away, even people who grew up there. While CA has it's pluses (weather, food, politics), it also would have been a much harder life for us, and to be honest, I don't miss it. 

An acceptable song by a boy according to a 4-year old

Justin Bieber, "Daisies"

A New Day

"While counsels of grandmothers meet around the world forecasting how to protect and nurture the planet, the women of the future are being born today. To be born is to be brave, a calling to fully participate in Earth life, and all its pain and glory, a self-educated guess, another kind of wisdom, a rich and exciting existence." -Pamela Anderson, Its Me, Pamela 

"And so it is: Life marches on, imperfectly. We age; we remain in the clutches of some painful patterns and scenarios; we grow out of others. In the hands of a large, mysterious universe, one thing is clear: we won't not be stretched beyond our limits, ultimately broken or broken open, and to what we do not fully know. Perhaps resurrection isn't best considered a big, one-time event; perhaps we learn it in tiny movements, with tiny decisions. Amidst all of it, we choose to keep showing up, stretching our hearts and legs to rise again." --Terri Dillon, No Pressure, No Diamonds

Aubrey Plaza was on a recent episode of Good Hang, Amy Poehler's podcast. (In my alternate universe life, I went to NYU for college and became best friends with Aubrey.) At the beginning of the episode, she compared the grief of losing her husband to the movie The Gorge. She said that it feels like "a giant ocean of awfulness that's like right there and I can see it. Sometimes I just want to dive into it, and just like be in it. Then sometimes I just look at it, and sometimes I try to get away from it. But, it's always there." I think that's a really good description for this experience. 

I've realized Mondays have become my wallowing in the awfulness days. The weeks are busy with work and school and life. We fill the weekends trying to do fun things with friends and the kids and catching up on chores. Then Monday hits, and I am home alone in the quiet. I am teaching all online this semester, so I only go to campus two days a week. My husband likes to do his in office days at the beginning of the week, so Monday, I'm alone. I usually do some laundry, clean the kitchen, and look for anything to do besides grade papers. So, I research brain cancer. I look for some magic answer that will tell me how all this will go. I check in with other families I'm following and moms I've been talking to. And I wallow. 

I like to scroll back through Andrea Gibson's Instagram page and read the pieces posted there. I haven't watched Come See Me In The Good Light yet and I haven't braved their substack yet, but it's on my list. It's a good reminder that its ok to embrace the grief and also acknowledge the amazing gift that is being alive. 

It's Tuesday, and I feel less like wallowing today. Here's a list of some good things:

  • Friends who insist on coming to visit, even when I don't want them to, who buy Wicked tickets without checking first, and who sit on my deck drinking White Claws and complaining about work. 
  • Going to concerts out of town with old friends, drinking way too much, and eating pizza with them at midnight. 
  • Parents who buy a house down the street without consulting me just so they have a place to stay when they come to help with appointments and child care. 
  • All of the people in our extended circle who have offered money, door dash credits, plane tickets, and places to stay when we travel. I am still learning that accepting help is a way of honoring those relationships.
  • Finding time to do art projects with the kids, even if they annoy me during the process. 
  • A husband insists we all look at the sunset every evening and who takes pictures of the moon from the driveway every morning. 
  • The sunsets from our back deck. 
  • Our cat who likes to get under the covers in my bed and press her claws lightly into my leg as she goes to sleep. 
  • K-Pop Demon Hunters dance parties in the living room.
  • Having my 4 year old lay on the ground in front of me and declare that she is pants as she folds herself up.  
  • Kids who creep into my room at 6am for cuddles, and knowing that it won't last forever, so I try to soak it all in and turn those fleeting moments into core memories for me and them. 
A Poem for a Change

Andrea Gibson, "Angels of the Get-Through"


 

Consent to Treat

We are at the beginning stages of PNOC022, and so far it is been a lesson is staying flexible. On September 23, we have a meeting with UCSF to discuss my daughter's eligibility for PNOC022, Cohort 5. They have a spot open for someone with an NF1 mutation, and wanted to make sure we were interested and ask some questions about her treatment so far before moving forward. Then, on September 30, we had the consent to treat meeting and signed all the documents. Now we are just waiting for them to sort out scheduling so we can go out there. 

The trial will require us to travel to San Francisco for about a week the first time. It is looking like we will fly out on October 19. I'm not sure of the return date yet. UCSF wants to do another set of MRIs and other tests to establish a baseline for her. We had a last minute appointment at our home clinic to do blood work and an EKG for the trial this past Friday. I also got everyone flu shots in preparation for all the plane travel. 

After that first week, we will have to go back out there once a month for a day or so each time. Like with her radiation treatments, my husband and I plan to alternate months, but my daughter has to go every time. I worry about the travel being too stressful for everyone. To make the choice more complicated, UCSF finally got in touch with Duke who said she would be eligible to get treatment there. The doctor at UCSF called me today to ask my thoughts, and I said that before we made any decision, we would have to actually talk to Duke. Regardless, we don't want to delay getting started on treatment. So, it is possible that we could transfer her care to Duke in the future. 

Last week I really felt like UCSF was the right choice for us. They have been communicative and on top of planning everything. Duke denying us really made me feel like the universe was pushing us to UCSF for a variety of reasons. But, today, the cost and logistics of monthly travel is really setting in. I applied for an airline points credit card and TSA pre check today to help with costs and time. We got a referral for the UCSF Family House where we could stay for free, but it won't always be available. My MIL's husband is still recovering from cancer, and she still quarantines when she travels, so I'm not sure they'd want us popping in every month with our fresh airport germs. The government is shut down and who knows how long the TSA and FAA workers will be willing to go without pay. It's just exhausting to think about, and I feel sad about all of it. 

My daughter got cast in the play at school again this year. They will have weekly rehearsals, and she will have to miss some. I'm really happy that she gets to be a part of it, but also sad that we have to think about travel and doctors appointments when making extracurricular commitments. 

I'm also sad that we have to leave my younger daughter home. I'm sad that she is being left out and that we don't have more time for her. I'm said that we haven't been able to sign her up for gymnastics and dance and soccer like we did for my older daughter when she was this age. Her birthday is November 1, and I'm sad I can't devote the time, money, and energy to plan a party for her. 

If we could transfer to Duke and we like them ok, it might be the better choice for quality of life. This weekend we made jellyfish lanterns for our town's lantern parade, happening October 25. I hope we will be back in time to go.

A Song to Get Out of the Monday Doldrums

Lindsey Stirling, "Monday Not Sick Anymore"