Mark reads with eyes closed while getting chemo


A Difficult Time for Mark: a time of great uncertainty
For people with cancer, periods of increased uncertainty must be unsettling even when improvement in their condition has occured. This seems true for Mr. Mark.
Mark is so upbeat and positive most of the time and I try to print the good news as much as possible, but the reality is that right now, he is still dealing with liver cancer, chemotherapy, side effects of chemo, and life decisions such as where he will live in the future, which depends on whether he is going to get better and how much better and for how long, which affects whether he can work or not, what kind of work he can do, how close he has to live to medical care, where he can have good access to care, and how to continue to pay for needed care. This is one of the most uncertain periods for Mark. When death seemed a certain thing, what was there to do but accept it and die, leaving all problems to others? Now that progress has been made in the battle against cancer he begins to wonder if he can hope for a future, but in the back of his mind is still the picture of death...not so certain, but it is still lurking there. The condo he leases is up for sale and he will probably get to stay out his lease until January, if it sells. Where will he go in January? Yet another uncertainty. This week I pushed Mark a little too much to do some business tasks and to think about whether he wanted to stay in Thailand, go to Saipan where he was when he was diagnosed with cancer, or come to the states and if so, where. It was stressful for Mark and mom backed off. While decisions will have to be made, stress is counterproductive to Mark's getting better and must be avoided. Mark may need your support now more than earlier as this uncertainty attacks his peace of mind at a time when he has more energy to worry. He truly appreciates any and all support. He told me in an e-mail this morning that he thanks God each day that he has me for a mom and a friend and he thanks God each day for those of you, strangers and old friends and acquaintences who support him in many ways. What may seem like a small support thing to you is really big to Mark.

Price of Treatment and Priceless Friend Petey: Mark continues to take care of Kuhn (Mr.) Petey Bird, the parakeet we found looking in the window of my 11th floor bedroom in Bangkok. He gives Petey a bath using a spray bottle. The little bird and Mark have bonded. As Mark has gotten better, his nerd skills have improved and he's now using Yahoo messenger for telephone calls computer to computer and using messenger e-mail for back and forth conversations. He has challenged me to get my technology more up to date and to get an avitar. He is putting music onto cell phones and making banana bread. He went to check out a restaurant he read about in the Bangkok Post and got nauseated and came home without eating there. I sent him an e-mail message and he wrote back: "I am busy being sick. Will e-mail later." Tonight he called and said he saw the doctor today and doctor T. tells him he is a poster boy and doing so well he should stay on chemo forever. Natuarally this does not appeal to Mark as chemo plays havic with his body and takes a toll financially too. Mark wants so much to hear that his cancer is gone and he can stop chemo. You can send him a card to encourage him. Cards and notes from friends and strangers mean a lot to Mark. If you are a stranger to him, tell him about yourself, your family, your job, your pets, etc. (Mark Richardson, Condo 6/11, Las Colinas Condominiums, 6 Sukhumvit 21 (Asoke Road) Wattana Bangkok, 10110 - 84 cents postage from USA).

Financial Concerns May Have surpased Worries About Dying. These past fourteen months Mark has worried about dying. In past months, it seemed a sure thing that he would die soon. Now that his cancer is responding to treatment, he worries about how he will continue to pay for treatment. We have spent a small fortune raiding our life insurance, bank accounts, and retirement funds to pay for treatment: enough to buy a fine car, small condominium and/or a boat (depending on the size of the boat). When diagnosed with cancer you can spend your money on such material things or you can spend it on treatment in hopes, against the odds, that you will get better. Mark is getting better.

Thanks to friends and strangers who have helped Mark
Some friends and a few strangers have contributed to Mark's care. You are wonderful. To these folks I want to say that we have appreciated, and continue to appreciate, your contributions toward the fight for Mark's life so very much. We love you for helping him while he is alive rather than saving your money for flowers in the event one of us dies. You are definately excused from sending flowers.

What does care cost in Thailand? Mark wanted me to tell you what care costs in Thailand. Here are some frequent and/or periodic approximate charges that are paid at each visit (At Bumrungrad Hospital, you can not return for care unless you pay your bill in full):
Oncologist's fee......$30.00
Radiologist's fee.....$50
Nursing service during chemo......$40/day
Chemo room........................$300.00
CBC...............................$30.00
X-ray.............................$7.00
24 hour urine creatine clearance $10.00
CAT scan.........................$600.00
1 nausea tablet sublingual .......$10.00
IV new nausea medicine.......... $30.00
1 neupogen injection.............$150.00
Ultra sound .....................$90.00
Hospital room ...................$100.00 - $125.00/day
Monthly 3-day chemo regimen .....$2,000 - $2,500
(including overnight hospital, doctor's fees, labs, nausea medicine, a neupogen injection, nurse's fees, IV's and chemo .....approximately)
Taxi fare to the hospital and back home .....$3.00

Many of you are asking...A donation of $30 to Mark's medical fund has paid for 10 trips to the hospital and back home or the doctor's fee for a visit or three pills to keep the nausea away. You can send a check for Mark's care to Highland Park Baptist Church 5206 Balcones Drive, Austin, Texas 78731 making the check out to the church; it's tax deductible. Put a notation on the check: For Mark Richardson Medical Fund. Enclose a note that your check is for Mark's medical expenses.

A Pretty Nurse Makes Mark Feel Better (picture taken April 2006, 8th floor, Bumrungrad Hospital, Bangkok, Thailand - Just before discharge after two days of a three day chemo regimen).
Every 3 to 4 weeks, Mr. Mark has a 24 hour urine done for catacholamines and a CBC. If all are good, he does 3 days of chemo. He is admitted on the 1st day to an inpatient room, but insists on staying dressed. He then goes to Horizon Cancer Outpatient Center for chemo. In the evening he is wheeled back to his inpatient room and his IVs infuse through the night. The nurses insist he put on a hospital shirt at least. Hospital clothing is a hospital shirt and pajama bottoms. This is much more dignified than the backless gowns of most US hospitals. Mark overnights in a hospital room and then goes back to outpatient for his 2nd day of chemotherapy. The 2nd evening he is discharged and comes back the 3rd day as an outpatient to get chemotherapy . The hospital stay drives up his cost but one type of chemo drug he takes requires the overnight stay, by Bumrungrad Hospital policy. The inpatient nurses all wear white uniforms and a nurse's cap. Some wear white high heeled shoes. They are very professional, knowlegeable, skilled, and feminine. They are totally polite and gracious. When Mark ring for the nurse, one comes immediately and gives the impression she has all the time in the world to help him. Nurses in Thailand are much like nurses were in the 1950's and 1960's in the United States. The doctor is like this too. As long as you have another question, he or she takes the time to answer. Review of your case is thorough at every visit.
Mark is always scheduled for a CBC a few days after chemotherapy. If his RBCs or WBCs are low, he gets an injection of erythropoeiten (RBCs low) or neupogen (WBCs low) and either one is costly. Mom gives Mark the injection to save money when she is in Bangkok.
A New Set of Problems Mark is not in as much pain and takes less pain medication. He has less nausea due to taking more nausea medication including a new one more expensive than the last expensive one which he also still takes along with licorice supplied by friends. While chemo still takes a toll for a few days with odd side effects creeping up at other times, Mark is much more energetic and full of thanks for all that others do to support him. The doctor tells him to take good care of himself now that he might win the battle against cancer. Mark shared with me that this takes some getting used to as he had prepared to die. Given a prognosis of three months to live, a person is told towork through the stages of death and dying and accept death. No one mentions that if you happen to live, that requires a whole new process to reverse your total acceptance and welcoming of death. Since Mark still has liver cancer, even if it is improving, he is in the twilight zone where he has to still be prepared to die and yet be exhuberant about life and prepare to live. Cancer is truly a roller coaster ride.
Mark tells me the problems when he was told he might live seem quite different from those when he was going to die. Living brings with it a whole new set of problems. Having run out of money and having no job was not a problem when he was going to die, but now he has to think about where he will live and work, and how to get such things as a job, health insurance, continuing education and licenses up to date, and a new pair of glasses, etc. We put our obituary writing session on hold to have time to think about problems associated with living.