A Remembrance Video of Mattie

Thank you for keeping Mattie's memory alive!

Dear Mattie Blog Readers,

It means a great deal to me that you take the time to write and to share your thoughts, feelings, and reflections on Mattie's battle and death. Your messages are very meaningful and help support me through very challenging times. I am forever grateful. As my readers know, I promised to write the blog for a year after Mattie's death, which would mean that I could technically have stopped writing on September 9, 2010. However, like my journey with grief there is so much that still needs to be processed and fortunately I have a willing support network still committed to reading. Therefore, the blog continues on. If I should find the need to stop writing, I assure you I will give you advanced notice. In the mean time, thank you for reading, thank you for having the courage to share this journey with me, and most importantly thank you for keeping Mattie's memory alive.


As Mattie would say, Ooga Booga (meaning, I LOVE YOU)! Vicki



July 14, 2009

Tuesday, July 14, 2009

Tuesday, July 14, 2009

I am thrilled Peter developed this for us. Please consider signing Mattie's LIVESTRONG Dedication Page -- For more information about this page, read the upper left hand side of the blog, or go to: http://www.livestrongaction.org/node/20612

Quote of the day: “The smallest act of kindness is worth more than the grandest intention.” ~ Oscar Wilde

Mattie had a hard time falling asleep on Monday. He finally went to bed at 1:30am. Needless to say at that point, I was not sure if I was coming or going. Despite going to bed so late, Mattie woke up at 9am raring to go. We played for several hours this morning, and then got ready and headed to the hospital for his appointment with Dr. Matt Biel, his psychiatrist. Dr. Biel and Mattie have a very good rapport, and Mattie was instantly engaged. Dr. Biel, Mattie, and I spoke for about ten minutes prior to Mattie's session. Dr. Biel wanted to hear from both of us how things were going at home. He also asked Mattie if there was anything he wanted to talk about today in the session. Mattie's answer was NO! Actually, he found the fact that we were talking simply "BORING" and wanted to know when the playing part of the session was going to happen. Some of the responses Mattie gave the doctor today were absolutely hysterical. For example, Mattie told Dr. Biel that when Peter and I disagree or argue about his medical treatment, that we never solve any problems or create solutions. I simply laughed, because from Mattie's perspective he just sees and hears our conversations, but he doesn't actually understand that these animated conversations are sometimes needed to come up with resolutions. Fortunately Dr. Biel and most of the Georgetown folks know Peter and I quite well. They practically lived with us for 11 months, so I am not as concerned about Mattie's off the wall statements. Before I left the session, Mattie told Dr. Biel that he had a secret. He then looked at me. I had no idea what was going to come out of his mouth at that point. Mattie knows I don't like secrets, and I told him to share it with us. He said to Dr. Biel, "you know I love my mom." So it was ten minutes of absolute laughter for me, to hear what can come out of my son's mouth!
Mattie had a good session with Dr. Biel. I hear that Mattie expressed some anger in the session, and most of it is coming out in aggressive play. Mattie will return for another session next week. While Mattie was in the session for 30 minutes, I had such high hopes to do things. I brought a book I have been trying to read for a year, I brought materials I had to read prior to the conference I am attending next week, and I also had to have lunch. I equate my feeling today to being on a bus tour. The bus stops, and the driver tells you that you have an hour to explore the city, but then tells you to make sure you are back on time, otherwise the bus will leaving. So today, I had to figure out what I wanted to do in this time period, eat, read, or what? I opted to eat, because I was sure Mattie wouldn't give me that opportunity once he was out of his session.
Once the session was over, I offered to buy Mattie ice cream, but he wasn't interested. I am more certain than ever that something is wrong with his stomach. He simply isn't hungry! We had an hour to entertain ourselves at the hospital before physical therapy began. Mattie did not want to go to the Lombardi Clinic, but instead wanted to take a walking tour of the hospital grounds. So in the heat today, I was pushing Mattie's wheelchair up and down ramps and so forth. I got my exercise, but that did not help my back what so ever! I am thrilled to report though that the transport chair arrived today! Thank GOD! So tomorrow, I will be operating with a 14 pound chair, rather than a chair that in my assessment must weigh close to 40 pounds.
Anna is unable to work with Mattie on Tuesdays, so instead her colleague, Cathy did physical therapy with Mattie today. Cathy has sat in on a few sessions with Mattie, so she is a known entity. I snapped some pictures of what Mattie accomplished today. He did tire easily, and I notice every time he exerts energy, he gets the chills and needs to be covered with a blanket.

Left: Mattie on the platform swing. Cathy is trying to get Mattie to stretch out "Steve," Mattie's right leg. Mattie managed to stretch his leg to a 29 degree angle today. Better than yesterday's 33 degree angle. Remember the goal is to get the leg completely straight, a zero degree angle.
Right: Mattie and Cathy worked on pulling these stretchy tubes apart, and then Mattie had to lift them up over his head. He was able to lift the tubes up passed his eyebrows.




















Left: Mattie went back to the parallel bars today, and tried to walk across them. But his arms were tired from the stretching, and as he walks, he drags and stomps on his left leg. In addition, Mattie just doesn't have the back strength right now, and walks hunched over. All things to work towards, but I am just so pleased that Mattie is motivated and a good sport about this. We are using a behavioral chart this week too, and his goal at the end of the week is to win a magnetic toy car.

Mattie and I arrived home at 4:15pm and started working on his Scooby Doo chia pet that Jenny and Jessie gave him yesterday for winning the boat race. Mattie is very excited to see these grass seeds grow. At 5pm, Marisa came over to play with Mattie so I could get out. I could see that Mattie did not want me to leave, but I have to fight this temptation to cave into his demands. So I did leave, and met up with Ann. We had a pedicure together and sat and chatted. Each time I am out in the real world though, I find it very difficult to integrate myself. I see others around me walking around, shopping, and doing the mundane tasks of life. What is mundane to most people, is extraordinary to me. I long for mundane. While out with Ann, Marisa called me and told me that Mattie really needed me to come home. I was further away from home than Peter, so I called Peter and he came home and relieved Marisa. These are the complexities of leaving Mattie, I just never know when I will get the call to come back home. Sometimes I wonder is it even worth leaving? But I know I have to start somewhere, until he becomes more comfortable with his independence.

Tonight, Peter and I had dinner on our deck. Mattie came out to join us, not to eat, but to play in his sandbox. He was really enjoying being in the sand, which was a wonderful sight to see and hear. For just that brief moment, things seemed like they were back to normal, where Mattie could entertain himself for a period of time. We want to thank Dawnee for the wonderful dinner she provided us tonight. Thank you also for the beautiful dessert treats! You spoil us and we so appreciate your support.


After dinner, Mattie opened up a couple of packages he received. My parent's friends in California sent Mattie this fabulous Sponge Bob plaque. He loved it so much, he posed for a picture and gave his best Sponge Bob face. Thanks Phyllis and John. I also love the Wham-It, Anti-Stress device. Thanks for passing it along to me. Your note was really great, and I love how you suggested I picture certain faces on this inflatable character before I hit it to alleviate stress, it made me laugh.
As I write this blog tonight, Peter assembled the new wheelchair and Mattie and Peter already took it out for a spin. Now they are sitting on the floor building a ferris wheel erector set that my parents sent him. As we head into Wednesday, Mattie has been invited to a hospital event in the morning, in which a brand new white Hyundai will be outside the clinic. Kids will be allowed to dip their hands in paint and put hand prints all over the car. Mattie hopes to see Brandon at this event! Of course Mattie has physical therapy in the afternoon, and then Louise (a graduate of SSSAS and a Mattie supporter), will be coming over to watch Mattie so that Peter and I can celebrate our anniversary. Peter and I weren't planning on going out, but Ann and our supporters are really looking out for us. I also think Louise is a remarkable young lady. She just graduated from high school, and yet on top of the other things she is balancing, she wants to help us.

I end tonight's posting with two messages. One if from my friend, Charlie. Charlie wrote, "Monday was a full day with the party and physical therapy. As you said, Brandon and Jocelyn are wonderful role models for Mattie. I know that he watches everything they do and that you will see the results of that at some point. I know the discussion with Dr Snyder was both saddening and frightening for you; I will continue to pray that Mattie has no need of any further chemotherapy and remains cancer free so that decisions about its impact on his system are moot. I think Mattie had a really busy day and perhaps more exercise than anyone realized which might be part of the reason for his meltdown with Peter. I believe that Mattie's emotions ride very close to the surface and when he is tired, you have a breakthrough that he does not know how to manage at this point. You and Peter are doing a great job as parents and as role models; you are also providing good models who are closer to his age so I am confident that Mattie will relearn those psychological skills just as he is relearning his physical ones."

The second message is from my mom. My mom wrote, "As to your odyssey to the hospital and back, it must be punishing for you to perform the same tedious routine on a daily basis but what must add to the stressfulness of your plight is having to keep to a schedule, maintain a semblance of order at home and then rush off to the hospital with Mattie in tow, only to maneuver through an antiquated run down poor excuse of a parking lot in hopes of finding a parking space. If the elevators work, you are in luck but from my experience I know that there are many days when they are out of service making it even more difficult to haul Mattie around in a wheelchair. No doubt the wheelchair feels heavier with each passing day. The body can handle just so much physical abuse before it rebels. As you pass through the hospital doors, you must feel that you have already coped with more than you can handle and yet the important work of the day is getting started. I sit down and contemplate what your routine is like and I am overwhelmed at the thought that you can still function and stay focused on your mission to give Mattie every chance to regain his health and lead a normal life. You have done and continue to do an awesome job. Keep it up but in the process be good to yourself!!"

July 13, 2009

Monday, July 13, 2009

Monday, July 13, 2009

Quote of the day: "One of the deep secrets of life is all that is really worth doing is what we do for others." ~ Lewis Carroll

Mattie attended Brandon's 19th birthday party at the hospital today. Brandon's mom and dad, Toni and Jim, hosted a wonderful ice cream party. Literally it was a chocolate lovers paradise. I had a brownie, chocolate ice cream, M&Ms, and caramel syrup. It was a delicious party, and Mattie was thrilled that there were vanilla cupcakes, vanilla ice cream, and even snow cones for him to enjoy. The wonderful treats made the day memorable, but what will stay clear in my mind always was the connections we made today. Mattie had a wonderful time with Brandon and Jocelyn (some of you may recall that Jocelyn cut Brandon's hair a few weeks ago, and she is a young adult with osteosarcoma). Brandon and Jocelyn are very good role models for Mattie, and I admire them both because they truly care about Mattie, and engage him in the clinic, and enjoy playing with him. Mattie did all sorts of fun projects today. He designed some sharks out of large clothes pins, and then Jocelyn and Mattie, chased Brandon around the clinic with these sharks. Mattie used his shark, to bite off Brandon's fingers, a leg, and an arm. By the time Brandon was finished, he was sitting in a wheelchair. Which led to wheelchair races between Mattie and Brandon. Jocelyn was cheering Mattie on.
We were also lucky enough to see Katie and Kathleen, two of our fabulous nurses from the PICU! They came to celebrate Brandon's birthday. We really miss them. It was so special to see them today, and it brings back all the same wonderful feelings to be in their presence. I will never forget my time with them, and part of me can't seem to visit them in C52 when we come to the hospital now. I am not sure why, but a part of me fears that our interactions wouldn't be the same, which is silly, but I always want to remember them and our connections the way they were. None the less seeing Katie and Kathleen today showed me that our connections transcend C52, which was a great feeling.
Mattie, Brandon, Jocelyn, and Jocelyn's sister, Hannah, also designed boats in clinic and then had boat races. Mattie designed a ferry boat, with a wooden car aboard it. Mattie and Jocelyn teamed up, and Brandon and Hannah teamed up. Jenny, one of Mattie's art therapists, was the judge of the race. Mattie revealed to Jenny that he had issues with racing and competing against his "best friend." His best friend being Brandon. Apparently Mattie brought some tears to his ladies today, because they found his loyalty and commitment to Brandon very heart warming. While Mattie was having this boat race, I was on the phone with Dr. Synder, Mattie's oncologist. Before I tell you about this conversation, I would like to share some photos with you from the clinic visit today.

Left: Vicki, Mattie, Katie (one of our fantastic HEM/ONC nurses), and Jocelyn. Notice that Mattie's hair if finally growing back!
Right: Mattie and Jocelyn attacking Brandon's fingers with their handcrafted sharks. Mattie gave Brandon the king crown today for his birthday.
















Left: Mattie and Jocelyn trapped Brandon in the clinic bathroom. Brandon resorted to sitting in a wheelchair because Mattie's clothes pin shark attacked his fingers, legs, and arms!
Right: You can see Mattie excited about the boat races! Naturally Mattie's boat won the race (thanks Brandon!), and Mattie won a prize, a Scooby Doo chia pet! Thanks Jenny and Jessie for the great gift. We started growing this plant today.




















While the races were underway, I chatted with Dr. Synder. She confirmed with me that she doesn't recommend Mattie receive any more doxorubicin, chemotherapy, based on its toxicity and effects on Mattie's heart. In addition to the decreased function in Mattie's ejection fraction and shortening fraction, I also found out today that Mattie's left ventricle of his heart is dilated, which means that it has expanded a bit and therefore fills more with fluid than it should. In addition, because of the extra fluid, not all of it can get pumped out. So in essence it is expected that Mattie will experience the following symptoms as he becomes more physically active: fatigue, shortness of breath, and dizziness. At the moment, it is hard to assess for these things because he isn't that mobile, but as he starts moving around, these issues may arise, and then we will have to figure out how to treat them, most likely with heart medication. In addition, it isn't clear if Mattie's heart function will continue to decline or whether we have reached a plateau. This is a bit daunting, because we just do not know what the future holds. I also feel as if Mattie would benefit from receiving more chemotherapy, but we are certainly not entertaining this because it would have a major impact on Mattie's heart. Dr. Synder has asked me to daily observe Mattie for shortness of breath and dizziness. I told her that this is another thing to add to my long list of observations. Right now, because I am monitoring so many things, I am keeping a spreadsheet on Mattie's status day to day!
Mattie and I said our good-byes to Brandon and his family, and Jocelyn walked down to the physical therapy clinic with us. Mattie was very proud to show Jocelyn what he is capable of doing, and Jocelyn showed great interest. In fact, Mattie recommended Anna as a PT to Jocelyn. Mattie told Jocelyn today that Anna is "the best!" I concur! I think Anna is working VERY well with Mattie, and I attribute this not only to her skills, but the fact that she developed a solid relationship with Mattie over the past eight months. I snapped some great pictures of Mattie in motion today.
Left: Mattie held a bat today and was whacking a balloon. He was stretching out his arms and really working hard.
Right: Mattie and Anna did some stretching together. Mattie can lift his left arm so it is at an 100 degree angle with his body. The goal is to get it to 180 degrees (ie, straight up over his head), but this is definite progress. In addition, Mattie's right leg is at a 30 degree angle, with the hopes to get it completely straight, or zero degrees.




















Left: Anna introduced Mattie to the parallel bars today. I was not sure how he was going to react to this, but he complied and walked across, bracing himself with his arms.
Right: Mattie crossing the finish line!











Mattie and I headed home and had a quiet afternoon together playing. When Peter came home, he and I had dinner outside, but Mattie refused to join us. Mattie's eating was a little better today, but still not great. We want to thank Eva Katcher for a lovely dinner! Thank you for your continued support! After dinner, I had a professional conference call to participate on. Not sure how I managed that, but I did. When the call was over, I could tell that Mattie and Peter were having a disagreement. So I went downstairs to find out what was going on. Mattie shut down, and was hysterical. Peter tells me that one minute they were playing and the next minute Mattie seemed angry and lost control over his emotions. Some how I am not surprised. Mattie is still in a very fragile place, which makes disciplining him and rationalizing with him like we used to ineffective. As we head into Tuesday, Mattie has an appointment with Dr. Biel, his psychiatrist, and then followed by his physical therapy appointment. Another full day at Georgetown. So though we don't live at Georgetown Hospital anymore, I still feel like I am very immersed in it.
I end tonight's posting with a message from my friend, Charlie. Charlie wrote, "As always, there is a sense of sadness that clearly permeates your lives right now. Throughout the blog there is a sense of longing for the way things were before the cancer that shows even through the positive things that do happen. I was glad to see that Mattie is becoming more comfortable with Independence and that you and Peter are taking advantage of the opportunity to reconnect with each other. I know how much doing for others means to you so I was happy to see that you had the opportunity to check in and spend some time with Ann's parents as well. I hope at some time in the near future, these opportunities become so routine that they are no longer remarkable and are once again a normal part of your lives."

July 12, 2009

Sunday, July 12, 2009

Sunday, July 12, 2009

Quote of the day: "In every walk with nature one receives far more than he seeks." ~ John Muir

Peter stayed with Mattie last night and helped him with bathroom runs throughout the night. For the first time in a week, I actually got a decent night of sleep, which was wonderful, but of course the past two nights came at a price to Peter. Mattie actually ate a full breakfast this morning of oatmeal, followed by homemade waffles. I was thrilled to see Mattie eating, but it is very clear to me that Mattie does still have nausea, and I would like to get a feeling for how long this will last, and for how long he will need anti-emetics.

Mattie was looking forward to seeing Whitney today. Whitney is a former childlife intern of Linda's, and Mattie gets a long very well with her. In fact, when Whitney came to visit, Mattie asked Peter and I to leave. He wanted his time with Whitney without us present. What a wonderful feeling to see him so comfortable with someone else.

When Whitney arrived she brought Peter and I a lovely anniversary card, and baked us a cake. Mattie was very excited to see the cake, all vanilla of course! Thank you Whitney! While Whitney was busy playing, and playing with Mattie, Peter and I went out to lunch. We actually ate outside, and despite being humid and 92 degrees in DC today, we loved it. Well maybe I loved it more than Peter, but Peter appreciated being outside and getting fresh air. We have both been SO trapped this year, that being outside is liberating. After lunch we did some shopping. It is Brandon's birthday tomorrow, and we are excited to be invited to his ice cream party at the hospital. Brandon has become such a special friend in our lives, I just wish we met him and his family under better circumstances. Peter and I picked up some more groceries to inspire Mattie to eat more, and then I went to visit Ann's parents for a little bit. When Ann and her family go on a day trip or out of town, I try, if I physically can, visit her parents in their assisted living facility. This may seem unusual to our readers, why do this in our time off? Two reasons. I did this initially because Ann does so much for us, and if there is a way I can reciprocate her kindness, I will do it. However, as time has lapsed and I have gotten to know Ann's parents, I consider them friends. I relate to them on multiple levels. I know what it is like to have a sick son (since they lost their son to cancer), and I also know what it is like to live in an institutional like facility. Even under the best of circumstances it can be lonely and isolating. So if Ann is gone, and I can spend an hour making her parents happy, then to me I have accomplished something that ultimately brings me happiness.

When Peter and I got home, Mattie was VERY comfortable with Whitney. They were sitting on the couch together and he was lying partly in her lap. I snapped a picture of these good buddies. It has been a good weekend for us, because we had periodic breaks. I appreciate Ann helping me coordinate this and persuading me to take this time away. The breaks are so needed, and it is during these breaks, we see how truly tired we are.

It has been an evening of laundry, playing, and chatting with JP (our neighbor). JP brought JJ (our resident Jack Russell Terrier) for a visit, and JP is encouraging Mattie to adopt one of JJ's future puppies. Mattie apparently is eager to have a dog in his life, but frankly I can bearly handle Mattie and our cat (who has been boarded for 12 months now!). Mattie says he would take care of the dog and walk it, but I know how that goes. I know I would be responsible for the dog, and right now, I can't even be responsible for myself.

Interestingly enough, Peter and I saw Mattie today, stand up and attempt to walk around our living room holding onto things. Mattie still doesn't put full pressure down on his right foot, but I can see he is trying to find ways to move around, and any time I see this I applaud his initiative.


As we head into Monday, we will be attending Brandon's birthday party, and then Mattie has a physical therapy appointment at the hospital in the afternoon. It is another full week of running back and forth to the hospital, and I assure you this is tiring alone. However, on top of this, factor into the equation the last 12 months we have had, the full time playing, and the sleepless nights, and this makes for a very interesting scenario.

I end tonight's posting with a message from my friend, Charlie. Charlie wrote, "It seems like Saturday was a pretty good day overall with Mattie enjoying a playdate with friends while you and Peter had some much needed time together. It is sad that it is easy to get out of the habit and ease of "togetherness" where it is difficult to share just because the opportunity is so infrequent. I am glad to see you and Pete rebonding over your nature project. Creating beauty and order out of weeds and disarray is good for the soul as well as a blessing to the eyes. Flowing water is calming and good for healing as well so how wonderful it is that you could clean up and restart this gift from Mattie and Peter. It's been a long hard year and just as gardens can be restarted and come to bloom, so can our lives and I hope this next year brings you many more flowering moments."

July 11, 2009

Saturday, July 11, 2009

Saturday, July 11, 2009

Quote of the day: "When we honestly ask ourselves which person in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares." ~ Henri Nouwen

Charlie sent me this quote today. In addition to Charlie's daily postings she also sends me daily quotes. I so appreciate her efforts and I just wanted to acknowledge her commitment to us and her contributions. This quote really spoke to me today, especially after the dinner I had on Friday night. This was a dinner in which I felt the art of being listened to and understood, and though it is unsettling that solutions are not necessarily evident to many of our issues, in the end, it is not the solution that makes me feel better. What makes me feel better is knowing I am not alone, and others are willing to walk this horrible journey with me. I can assure you on some days, I would imagine it would be easier for some of you to just walk away. I joke with Ann about this all the time. Because though we are living this nightmare with Mattie, Ann and our Team supporters are right along side of us. Part of me wonders how you all handle the news each day, and yet not become so overwhelmed that you land up wanting to turn off your computer!?
Peter stayed with Mattie last night, so I could get a night of sleep without jumping up and down helping Mattie to the bathroom. Mattie is up at least two to three times a night, since he remains on prescribed IV hydration. However, despite being separated from Mattie last night, I had so much running through my head that I did not fall asleep until 3:30am, and by 6am, I was wide awake. Of course tired though, but rest wasn't happening for me. I also woke up not feeling well, and I am slowly turning a corner now, but feel very wiped out.

Mattie was invited over to his friend, Campbell's house today. We can't thank Christine and James (Campbell's parents) enough for this five hour break. The intention was to celebrate our anniversary which is coming up next week. But after last night's dinner, I gave some serious thought to what Peter and I should do today. When we have free moments which is RARE, there seems to be so much we want to do. Our big goal is to go through 12 months of things stacked around us at home so we can reclaim our space. We have also wanted to tend to our garden boxes (which have been filled with weeds due to months of neglect). Of course it is our anniversary, so technically we could have also dome something special. However, Peter and I are both not in that kind of mood, and decided instead to take on a project together at home. Clearly the digging through stacks of things is a priority, but both of us wanted to spend time outside today. So we decided to buy plants, and then came home and weeded and planted. I am sure that sounds like an absolutely boring way to spend together, but gardening is something Peter and I have always loved to do. We get a lot of enjoyment in being outside and taking in the beauty of plants and flowers. In addition, before Mattie got sick last July, he and Peter hand crafted an outdoor fountain for me. So today, we cleaned it out and got it up and operational. To me there is nothing better than the sight and sound of water. So after giving Ann's question some thought last night, I did find something today that I still enjoy. That is nature, the beauty of flowers, working hard to establish a garden, and the opportunity to work with Peter as a team to put this garden together. So in essence this was our anniversary gift..... time together, and time to talk in an uninterrupted fashion. This is priceless. Before we did all this planting though, we went out to lunch together, which was nice. It is so unusual for us to be able to just sit down in peace and eat, so when it happens, it takes us a while to settle down, but it takes us only seconds to appreciate these moments. I included a picture of part of our garden area, featuring Mattie's fountain in the center!
Peter went to go pick Mattie up at Campbell's house and by that time, I think Mattie was tired. But he had a busy and fun day! He did legos and also worked on some wonderful crafts that he gave Peter and I for our anniversary. Thank you Christine for thinking of this and for helping Mattie gift wrap them. The pictures of Mattie that you included were wonderful, and it reminded me of happier times. I took a picture of the items Mattie created for us. To me, these handmade gifts are so meaningful, and things I will always cherish. Mattie was very proud of his accomplishments and he felt happy that he could celebrate our anniversary in some way.
Left: A trinket box that Mattie made for me, with a picture of himself. In addition, inside the box was a piece of quartz that Mattie wrapped up for me as well.
Right: Mattie created a picture frame for Peter, and the picture of Mattie, I believe was taken during Campbell's last birthday.





When Mattie got home, he felt nauseous. This is something I need to talk to Dr. Synder, Mattie's oncologist, about. This stomach issue doesn't seem to be going away, and everyday I need to give Mattie his IV anti-emetic. I made dinner for us tonight, but Mattie refused to sit outside with us on the deck. Normally I would have caved into his desires, but tonight, I let him sit inside, and Peter and I went to sit outside and have dinner together. It was lovely to be able to sit outside, not to be confined indoors, appreciate our plantings, and hear the sound of Mattie's fountain in the background. As we head into Sunday, Whitney and Lesley (Linda's former Childlife interns) are coming over to spend time with Mattie. So this has been a weekend of breaks for Peter and I. I did not think this was going to make a bit of difference to my mood, and I still have my moments, but I can see these breaks are very necessary. It is also during these breaks that I realize just how physically awful I feel. I know Peter isn't far behind me, because planting today in a way was very taxing for us.
I end tonight's posting with a message from my friend, Charlie. Charlie wrote, "What a difficult day Friday was. To be a full time playmate, caretaker and parent is really exhausting and even more so when dealing with Mattie who is limited in his mobility. When I was reading the blog at first I thought I am sorry that Peter did not get to go to dinner but, I think that it was actually helpful that it worked out that way. Mattie has more strength and more resilience than he wants you to know. He's become used to having you around to help and facilitate everything he needs so naturally he is unwilling to give that up. If Peter had gone with you last night, you would have heard only Mattie's view of the evening which was much more negative and you would have probably felt even more guilty for spending some time away. I am so glad you got to go out with Ann and Karen because even if there are no immediate solutions to be seen, it is helpful to have the issues heard and acknowledged. I am glad to see you trying to let go of the guilt (undeserved but naturally felt) so that you can focus on healing for both yourself and Mattie."

Friday, July 10, 2009

Friday, July 10, 2009

Quote of the day: "Kindness is more important than wisdom, and the recognition of this is the beginning of wisdom.” ~ Theodore Isaac Rubin

Before Mattie woke up this morning, our in home medical supplier delivered me a lightweight wheelchair. This delivery was an absolute riot, because this new chair was as heavy as the current chair. So I refused to accept the chair, and contacted Catherine, our case manager at the hospital. To cut to the chase, insurance doesn't cover transport wheelchairs, which is really what I need because of its very lightweight nature. So I did some searching around on the internet today, and purchased a transport wheelchair that is only 14 pounds. I am hoping this makes things a lot easier for us.

Mattie and I had a FULL day of playing together. We did a lot of trains, legos, and pretend play. However, several hours of play can be very tiring, on top of my already tired state. Typically Dan, a Georgetown University student, helps me on Fridays, but Peter and I were going to go out to dinner with Ann and Dr. Bob tonight, and we asked Dan to watch the kids this evening instead. As the afternoon rolled by and it was getting closer to the time for Mattie to leave for Ann's house, he had an absolute meltdown. He said he was in pain, he was nauseous, and did not want to leave or be without me. I tried rationalizing with Mattie, gave him some pain medication, and his anti-emetic and told him he would feel better soon. However, that moment did not present itself. The more I tried to help him work this through, the more upset he got. He made things so unpleasant that I figured there was no way I could possibly leave him with a sitter. So I called Dan and cancelled his visit, and then called Ann and told her we weren't going to get together. Ann could tell I was upset and at my wits end, and the thing that really bothered me was that Mattie did not want to leave the house because he said I did not spend enough time with him today. Mind you we were together solidly for the whole day, as we are everyday. So I clearly felt like he was manipulating me and the situation, and using pain as the excuse and the controlling factor. It is becoming very apparent that we need to take back control of our lives in our home. For the past 12 months, certainly we have been Mattie's parents in theory, but because of the circumstances we had to be around the clock caregivers and playmates. This is different from being his parent in many ways, or let's put it this way, it makes it very challenging parenting a child with a life threatening illness who spends more time living in a PICU than at home. So as a result the aftermath of this illness is a balance of power that is skewed in our home, and now we are having a meeting of the minds with Mattie as we take back control over our lives and our family. This transition isn't going to be a smooth one, and today was a perfect example. However, it isn't good for Mattie to isolate himself or me, and in many ways, I have to find my former parenting skills that I hung up on a coat rack 12 months ago and start applying them again. I am not saying that we provided no discipline or structure in his life this year, on the contrary I think we did the best we could under the circumstances.

I made it very clear to Mattie that his decisions have consequences, that by not going to Ann's this impacted other people's lives. I told him I was disappointed in his decision, because it was an opportunity to spend time with his friend, and also an opportunity for me to do something that involved getting out of the house. I let him sit with that for a while and about 30 minutes later, he decided to go to Ann's house on the condition that Peter or I stayed with him. So despite Peter looking forward to going out with us, he stayed behind at Ann's house, and I went out with Ann and another RCC mom and friend, Karen. I viewed tonight as a mental health break, because I couldn't spend another minute trapped at home. We had a lovely dinner out (thank you Ann!), but as usual, though not my intention, I feel like I have a way of dragging down a conversation. Ann and Karen tried very hard to help find solutions to certain issues Peter and I are contending with now, but like I told them, sometimes things can be so challenging and overwhelming, that I can't even conceive of a solution or action to lighten our tasks. None the less talking through the stresses and being heard for me are powerful gifts and help me process my thoughts and feelings. A typical day for me means that I rarely have a meaningful adult conversation or have the ability to express how I am feeling, so tonight was a very special moment. Tonight did show me though how pervasive Mattie's illness is in my life, and when Ann asked me what would be something fun for my family to do together, and I couldn't answer her, which was enlightening to me.

When we got back to Ann's house after dinner, it was late, and only Mattie, Abigail, JP (Ann's cousin), and Peter were up. In the car ride home, I asked Mattie if he had a good time. Mattie started to tell me that he did not have a good time at all, but then Peter stopped him. Peter told me that Mattie did indeed have a good time, was animated, and ate well (we want to thank the Peterson family for the dinner they provided all the kids tonight, thank you for your continued support!). However, this is not the picture Mattie was trying to portray to me. So part of me feels as if Mattie was trying to make me feel guilty for going out and leaving him for so long (as he did mention to me!), because from Peter's assessment, Mattie was doing great the whole time. Many of my issues revolve around how long I will have Mattie in my life, and this fear drives many of my choices and actions. So I land up feeling guilty if I miss a minute with him, however, I am also very aware of the fact that I am exhausted physically and mentally, and I have to let this guilt and other stuff go, in order to focus on my own recovery from this nightmare. It is now 2:30am, and I have no idea if what I am writing is even coherent, but hopefully you get the picture of what our day was like.

I end tonight's posting with a message from my friend, Charlie. Charlie wrote, "Thursday was certainly a day of ups and downs. I simply do not understand medical professionals who have no connection or understanding of the patients they are working with. The cardiologist was incredibly insensitive and obtuse with regard to Mattie and his situation. Maybe after the confrontation with you she will be a little more respectful of her patients' needs. One can only hope. I am sure it was difficult to focus on what she said during the conference with Mattie in the room. It is hard to know what he absorbed of that conversation but you need to be prepared for Mattie to raise some issue with it at a later time. As for the comments of the other osteosarcoma mom, well, I am sure that what she said goes through the mind of every parent who has a child in a life threatening situation. Whether one opens up that conversation with another parent is a different thing altogether. Every parent's beliefs are their own, each child's situation is different and expecting some sort of consensus on an intensely personal topic like that just isn't possible. In fact, most parents' opinions will change day to day or even more frequently depending on what is happening at the time. As Dr Snyder said, no one can (or should) judge your decisions. Only you and Peter know what is right for you and for Mattie. And on the positive note, I was delighted to see Mattie working so hard at therapy. It looks like a good motivational process is in place; I hope it continues at a good pace."

July 9, 2009

Thursday, July 9, 2009

Thursday, July 9, 2009

Quote of the day: "What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others." ~ Pericles


Mattie shocked me last night. He went to sleep at 10:30pm. I decided to also go to sleep at that hour, but it wasn't easy for me, since I am used to staying up until 1am or later. Mattie was up at 4am, 6am, and then finally got up at 8:30am. As much as his bedtime hour surprised me, how he greeted me this morning truly caught me off guard. I had just gotten out of the shower, and I heard rustling in Mattie's room, and before I knew it, he managed to slide on his rump to his bedroom door and open it. We both startled each other and then laughed. I made a big deal out of his initiative and he felt very proud. Though I felt I needed to ask him if he would have done this if he was connected to his IV, and he said NO, which was the right answer. I learned my lesson early on the hard way. I left Mattie unattended one morning connected to an IV, and the next moment I checked on him, his line was filled with blood. I was in a panic, because I did not know if he was bleeding, pulled the central line out of his chest, or what. So now if I leave him unsupervised, it is always without an IV attached.

Mattie and I arrived at Georgetown Hospital at 11:20am, for his 11:30am cardiology appointment. Needless to say we did not get home until 5pm. Another long day in the hospital for us! Linda met us in the cardiology department and helped me throughout the entire process. I am not sure where I would be without Linda (Georgetown's Childlife Specialist). I am not just saying this, I truly mean it very seriously. Linda has helped me under the worst of circumstances, and she isn't only a calming factor in Mattie's life, but I fully admit, Linda is important for me as well. Without Linda, I would be going through scans, testing, and other daunting procedures on Mattie alone. I can assure you it is frightening to do any of this, and now as we are off active treatment, this process is almost terrifying. Mattie did quite well through the EKG and Echocardiogram. The techs were lovely and they had Sponge Bob playing in the background, so Mattie was glued to this yellow creature. The problems arose once the testing was complete. The tech told Mattie he could get up, but his shirt on, and could go back into his wheelchair. Big mistake. The next thing we knew the cardiologist came into the room, and told Mattie she wanted to speak with me privately and then would come back to examine him. I told her she should examine him first so that he could go back to the Lombardi Clinic with Linda and play. I am sure I caught the doctor off guard. Most medical doctors don't like to be directed by their patients or the patient's family. She did agree to examine Mattie first, but wanted him to take off his shirt and get back up on the exam table. Now you have to understand getting a shirt on Mattie isn't easy with all of his surgical sites, and I had just lifted him back into the wheelchair. So when she told us this, I just looked at her, and I basically said she had to be kidding. I am sure I was labeled as the problem MOM of the day, but I frankly did not care. Her whole demeanor with Mattie was gruff and insensitive. Though I find most people in a hospital setting have very little knowledge of how to work with kids who have had limb salvaging surgeries. It is almost as if this is either so rare, or simply not discussed in one's medical training. Any case, the doctor agreed to examine Mattie in his wheelchair and with his shirt on after I barked at her. Mattie did not like the exam, but when she started pressing on his stomach, he lost it, and I never got him back at that point! He kicked and punched the doctor. Many of the behaviors I remember Mattie doing as a toddler have resurfaced, which isn't surprising since under times of crisis, we go back to our familiar behavioral patterns. Those patterns for Mattie involve no verbal communications, and simply acting out and expressing emotions with his body.
After the exam was over, Mattie refused to leave my side. He wouldn't go down to the clinic with Linda, and in fact he told Linda to leave. I felt bad for Linda, and then I felt bad for myself and Mattie. It wasn't a pretty picture. We spent at least 20 minutes rationalizing with Mattie. I had to meet with the cardiologist to give her a history and to discuss the results, but Mattie refused to leave me. So I had no other choice but to take him into the meeting with me. So Mattie heard the results of the testing, but was quiet throughout the meeting. In essence the cardiologist told me that Mattie's results were similar to the ones presented in June. Specifically, Mattie's shortening fraction (a way of measuring left ventricle performance. Instead of measuring and ratio-ing blood volumes, the shortening fraction measures and ratios the change in the diameter of the left ventricle between the contracted and relaxed states) and ejection fraction (measures how the left ventricle, a chamber in the heart, relaxes to fill with blood and then contracts to pump the blood out) have decreased in function. So she labels him as having heart dysfunction, as a result of the toxicity of the chemotherapy Mattie received. The cardiologist is opposed to giving Mattie more Doxorubicin next week. Doxorubicin is a chemotherapy Mattie had over the course of the last 11 months, and it is very cardiotoxic clearly. However, Mattie hasn't received his lifetime dosage of this drug, and therefore it was decided before today's testing that two more dosages of this drug would be beneficial for Mattie. However, today, I was crushed to hear the cardiologist's recommendation, because Peter and I both feel that more chemotherapy is necessary to potentially kill any dislodged tumor cells that may have occurred during Mattie's sternotomy. As you know, three of Mattie's lung lesions were viable tumors. In addition, the cardiologist explained that this damage to the heart is most likely permanent, and this dysfunction could continue to get worse over time. The cardiologist talked with me about Zinecard, which is a heart protector drug that is sometimes given to patients before receiving high dosages of Doxorubicin. Some of you may remember that I pursued this drug for Mattie, but Georgetown kept telling me it was in a national shortage, and Mattie really did not need it because the toxicity of Doxorubicin he would be receiving wasn't that high. However, as his mom, I can't help but think that I shouldn't have settled for this answer. I should have demanded they find the drug. Yet the catch is if I waited for the drug to be located, then this would have held off Mattie's chemotherapy treatment. Damned if you do, damned if you don't, because we know he wouldn't be here today without chemotherapy. I can't look back on this decision, I have to trust that this drug was indeed not available as was told to me, and that it was the right decision to start treatment as soon as possible. But a part of me wonders, if he got Zinecard, would we still see these heart dysfunctions today?

Mattie and I then headed to the Lombardi Clinic after this appointment. I decided to take Mattie to clinic for two hours, because it made no sense to run home, just to come back for a physical therapy appointment. The clinic was an absolute zoo today. Jenny was away, and Jessie was there and working with eight children at one time. At one point, I looked over at Jessie, and all the kids wanted something from her at the same time, and yet she remained calm, helpful, and always professional. In all reality a TV crew should have been in the clinic, because this would have been a perfect clip for a Tylenol commercial. How Jessie managed all of this without developing a headache by the end of the day is a miracle. Jessie helped Mattie, despite being pulled in a thousand directions. They designed a box for the rubber frogs that Linda gave Mattie earlier in the day. In fact, they made a beautiful pond out of a cardboard box along with lily pads. While Mattie was working on this, I had the opportunity to speak to a mom I haven't seen in a long time. Her daughter is an osteosarcoma survivor. However, while I was talking to her about Mattie's condition and the additional concerns we now have about him, she happened to say to me, when do I think enough is enough?! Meaning how much more will I put Mattie threw. I guess this caught me off guard, because I assume all parents with kids who have osteosarcoma are going to fight until the bitter end. If something can be done, you do it. Any case, her comments stayed with me all day. In fact, Ann called me when I was in clinic and I guess I must not have sounded like myself, and she was concerned.

I guess what I am learning by all of this, is I feel incredibly stuck. My life will never be normal. I will continue to live my life making life and death decisions for Mattie, in hopes of saving his life, or giving him a chance at it at least. But what happens if all of this is for naught? How do you keep on living without your child? I don't have an answer for this, other than now I know I am profoundly sad and deeply impacted by Mattie's illness. This illness has absorbed me, and nothing I do really can allow me the chance to forget about it. I am drowning in all sorts of emotions, that I can't particularly express it too well tonight. I did write to Dr. Kristen Synder today, Mattie's oncologist, who is on vacation. But Kristen responded right back. We talked about the cardiology results and she also told me that no one can judge the decisions we make. What truly touched me is she said, "but it is only after we have walked a mile in your shoes that we can even suggest we know how you feel. And, Vicki, in this case, a mile just isn't long enough to even remotely comprehend what you are going through." Kristen isn't only a competent doctor, but a doctor with a heart and great understanding. Which is why I can't say good-bye to her as she leaves Georgetown full-time.

Mattie had another productive physical therapy session today. Linda joined us for part of it, and helped me take pictures and also participated in a scooter race with Mattie. Normally I try to play an active role in therapy, but Anna can see my back hurts. Anna and Catherine, our case manager, are on top of the wheelchair issue, and tomorrow our in home supplier is coming to take back Mattie's current chair and are giving me a lighter chair. We shall see what this looks like. I think the photos from today's session, will give you an idea for what was achieved.

Left: Linda got into the tube that Mattie was throwing balls into and snapped a picture. You can see that Anna has Mattie sitting on a structure that forces him to put weight on both feet, so he has to balance himself.


Right: Mattie and Linda racing. It was a right foot race only. So it was "Steve" vs. "Froggy" (Linda's right foot).





















Left: Mattie working hard to get around one of the cones in the obstacle course.
Right: Mattie foot painting! Mattie LOVED IT!



















Left: Mattie decided to paint Anna's mirror with his feet, which is fine, because it gives Mattie the opportunity to stretch his legs and build up strength.
Right: Mattie holding up his behavioral chart. He was successful and did everything he was asked to do this week! You can see the stickers for each day of work.





















Left: Mattie's well sought after prize. He has wanted this ball all week, which Denise, his social worker, was holding for him! He already knows what he wants to work toward for next week. Excellent.

On the car trip home, Mattie fell asleep in the car, which is excellent. That means to me that he was working hard with Anna. I did not let him sleep for more than 15 minutes, and then woke him up. We want to thank the Murphy family for a wonderful picnic dinner. Mattie loved the pasta, broccoli, and watermelon. He actually ate quite well. I am a fresh vegetable fan, so I appreciate all the wonderful farm fresh vegetables! Thank you Elizabeth for the lovely gift as well. I will happily use the the green tea lotion and soap. Thank you for thinking of me and your continual support of my family.
After dinner, Peter took Mattie out for another walk. They walked by the water and I hear they saw a mother duck and her ducklings. Mattie and I have a wonderful story about a mother duck and her ducklings who we saved about two years ago in a storm drain. I always wanted to develop a children's story out of it, and perhaps one of these days Mattie and I will do this together. He reminded me of our duck rescue tonight! I am happy he can remember these special times together.
I end tonight's posting with a message from my friend, Charlie. Charlie wrote, "It sounds like Mattie is beginning to get into the idea and routine of physical therapy. I know you are happy about that because cooperation is so critical to getting well. I hope you can find an appropriate lightweight wheelchair to use until Mattie is ambulatory again. Lugging a heavy chair around, especially in and out of a vehicle is awkward and oftentimes leads to an injury for the helping person. However, the thing I wish most for you right now is the re-creation of family routines (meals, walks, bedtimes, etc) and Mattie's acceptance of the need and respect for those. I know that once that happens, the start of healing emotional wounds will not be too far behind."

July 8, 2009

Wednesday, July 8, 2009

Wednesday, July 8, 2009

Quote of the day: “Life is all about timing... the unreachable becomes reachable, the unavailable become available, the unattainable... attainable. Have the patience, wait it out. It's all about timing.” ~ Stacey Charter
You would think between physical therapy and a long walk outside last night with Peter before bed, Mattie would be tired by the end of the day. But sadly he isn't. Mattie was up until 2am on Tuesday. Needless to say, you know who was up right along side him. Last night we played a made up race car game and then eventually took out his computer and we designed a lot of wonderful pictures on it. Mattie even showed me how we could record our voices on his computer and play them back. So he decided to sing a song and record that. He made up a song about loving me. It was very cute, and it is in these simple and spontaneous moments, you see why this torture is all worth it. We had a fun time playing together, but by 2am, I couldn't play another minute. The lights went off, and I could hear Mattie still up, but eventually he fell asleep.


This morning, I woke up before him, as I usually do. While I was in the shower, I could hear someone pounding on our front door. But the pounding did not stop. So I got myself together quickly in order to find out who it was. It was someone to fix our air conditioning unit. But the fun did not stop there. Over the course of the next three hours, people keep knocking and coming on in. At one point I had four different people fixing something in our home. You may be asking why was all this going on? Well things have been breaking down in our home for months now, we report them, but because we haven't been home to follow up on these repairs, they haven't gotten done. Some of the complaints are serious issues, such as our balcony door was sealed shut and we haven't been able to open it for months. This happened when the complex did that massive construction job I told you about back in April. Well now it is July, and NO ONE ever responded to our several calls to repair this door. So in my usual fashion, which I perfected this year out of necessity, I called our complex manager and gave her a mouthful about my disappointment about service and follow through. This explains why people were jumping today, in fact, almost all the things I have requested to be repaired over the last months, have been addressed today. Amazing, isn't it?! One of the people who came to fix my screen door, was absolutely hysterical today. He took out his cell phone and had a personal call for 30 minutes on my balcony. Under most normal circumstances I would have said something, but today, I was more fascinated by his total lack of regard for his job and the fact that he could see I was busy with Mattie. But all these people working in our home and managing them was a little more than I bargained for today.
Mattie was just watching all the action around him as things were getting repaired, and this 30 minute personal phone call was so noticeable that even Mattie asked me why this man was on the phone for so long. In the midst of all this chaos, I did get Mattie ready for his physical therapy appointment. I find it interesting to note, that yesterday and today, Mattie has brought a toy or something to play with to physical therapy. But it is a mindful selection, because he is bringing something he can incorporate into his sessions. Yesterday was these bendable sticks called Bendaroos, and today Mattie brought in these bug toys that can crawl down surfaces such as mirrors and walls. Mattie thought that he could use the bugs during his standing and reaching part of the therapy session. Anna was thrilled to see Mattie's initiative!

Mattie had another good physical therapy session today. He is motivated to complete his behavioral chart, because after accumulating so many stickers on the chart he can receive a rubber ball which is being held for him in clinic. Mattie did exercises to strengthen his right foot, which entails standing, stretching, and reaching. You can see Mattie having a foot race with Anna on a mirror. The rubber balls attached to the mirror were part of the obstacle course Mattie set up.




















Mattie also spent some time standing up and throwing balls into a barrel. He actually did very well on this task, and we kept reminding Mattie to put pressure on his right leg while standing. At the moment, he really shies away from using this leg altogether. I love this picture though, because you can see the ball Mattie threw in mid air, and he is very focused on it and for it to make it into the barrel. Mattie also allowed Anna to stretch out his right leg. So overall, I would say it was another productive and successful physical therapy session. Unlike how therapy progressed upstairs in the PICU, therapy now is still fun, but it is more focused, productive, and tailored to meeting the goal (which is to get Mattie stronger and up on his feet). I can actually feel the difference. So hopefully so does Mattie.
After our appointment was over, we got back home, and Mattie continued on me to play with him. However, I needed a break, my back was aching from lugging the wheelchair, and I needed to take Advil today in order to proceed on. I have talked to Anna and Catherine, our case manager, about a lightweight transport wheelchair. Thank you Lauren for mentioning this and I thank Charlie for capturing the information on line for me!
When Peter came home, we encouraged Mattie to eat something, and helped him a bit. But then Peter and I sat outside on our deck for 30 minutes to eat dinner without being interrupted. We wanted Mattie to join us, but he refused. I am trying to claim back time where we are all eating together again, and I figure if Mattie doesn't join us, maybe observing us will be helpful or inspire him. There has been a lot lost this year, and family meal times is just one of the things I could name right off the top of my head. We would like to thank Jill K. for a lovely Greek dinner! Thank you Jill for supporting us all the way from Canada!
As I am writing this blog, Peter took Mattie out for another walk. They have been gone for 50 minutes. I wish the fresh air would knock Mattie out, but at least the change of scenery is good for him. As we head into Thursday, Mattie has an echocardiogram at 11:30am, and then we will spend the rest of the day in the Lombardi Clinic until Mattie has his physical therapy appointment with Anna at 3pm. It makes no sense for me to run back and forth with Mattie, especially moving that wheelchair. This echocardiogram is important, because it will dictate whether Mattie qualifies for more chemotherapy next Thursday and Friday. So stay tuned.
I end tonight's posting with a message from my friend, Charlie. Charlie wrote, "Getting well is a process. What you have been through in the last year was not about getting well, it was about survival. Now that you've come through that you can begin to look around and plan for the healing process. I agree with you that experiencing camp with other survivors would be a good move for Mattie. He would be with counselors and children who understand what he has gone through and the situation would be set up so that he could do creative and interesting things in spite of his physical limitations. Many of the children who attend these events get to try things they did not get to do before they had cancer like horseback riding or other sports that use adapted equipment. Tuesday's physical therapy session looked like it went well and Mattie clearly worked very hard at it. It appears that the talented therapists have come up with a reward system that will work for Mattie. Learning to use muscles that are unaccustomed to full range of motion or bearing weight is very exhausting even if it appears to be a game. The positive side of this is that the exercise will probably help Mattie sleep better. I have to tell you how much I admire your well thought out and measured response to Mattie's statement of "not liking himself". It is difficult to shut down the auto response of "that isn't true" or "but we love you" etc, to really hear what is behind the statement. I think that is so important and reinforces Mattie's sense that his concerns are heard and validated. He needs this to be able to move forward into healing."

July 7, 2009

Tuesday, July 7, 2009

Tuesday, July 7, 2009



Quote of the day (Thanks Daddy!): "Life must be lived forward, but it can only be understood backwards." ~ Soren Kierkegaard



My Dad sent me the above quote weeks ago, and when I first read it, I liked it a lot. But I did not post it on the blog until I was in the right mood, and it fit the message I wanted to convey. Well that moment has come! I think what I like about Kierkegaard's quote is it illustrates to us how to conceptualize and understand a child whose body and mind have been ravaged by cancer. Certainly any of us on a given day live our life moving forward. After all, we are a very future oriented society. But for most people, and especially children with cancer, it is impossible to move forward, without looking back at that person's history (in this case the type of cancer, the treatment, the extent and duration of treatment, where the treatment took place, the family system, etc...). By looking back, it explains many of the issues, feelings, and behaviors present before our eyes today. Or in other words the aftermath or the shell of the patient we see today. Denying the past only denies a richer future. I had a revelation today, or maybe I knew it all along, but faced it today, that in order to free Mattie to move forward, I must help him understand what happened during these last 12 months. It is only by coming to peace with the past, that the true Mattie will be able to develop and unfold. What sparked this revelation today? Plain and simple, it was something Mattie said to me while awaiting his physical therapy appointment. Keep reading, I will explain this in a minute.





Before I tell you more about my revelation, I wanted to share the finished LEGO carousel project with you. I need to take a picture of it during the day time hours, but this will give you a feeling for its intricacies and amazing moving parts! This was such a labor of love, and there is no way I am breaking it apart for a while.



Mattie went to bed at 12:15am on Monday. Though that sounds late, that is actually early for Mattie. I am hoping as he gets used to being home, that this bedtime hour will continue to become earlier. We are certainly working toward that. However, Mattie was exhausted this morning and couldn't wake up. At noon, I woke him up, and got him ready for the day. He had physical therapy today at the hospital. Our appointment time is 3pm, Mondays through Thursdays. This is the time when the PT gym isn't as crowded and Mattie can have more free rein over the equipment there. I did speak to Anna today about a different wheelchair for Mattie, because I can't keep lifting this chair in and out of the car day in and day out. It is way too heavy, and in my more weakened condition, I could land up hurting myself. Actually my biggest fear is something happening to myself or Peter, because this would be bad news for Mattie.



While Mattie and I were waiting in the PT waiting area, Mattie turned to me all of a sudden and said, "I don't like myself!" That is an enormous statement, that could mean anything. Instead of placating him or trying to insert my own thoughts into his thinking, I stopped myself, and asked him to tell me more about this statement. At which point he became closed off. However, a few minutes later he went on to say that he has never liked himself. I did not think that was true, so I said did he feel this way always or after he got sick? He admitted to feeling this way after he developed cancer. Then specifically stated that what he doesn't like about himself is that he "had surgery." He doesn't like that he has scars, that he can't walk, and that he can't do anything for himself. This was a lot to hear in the middle of a waiting area, when PT was about to start. All during his PT session, I tried to process how he was feeling. I certainly don't blame him one bit. He looks different, he feels different, and he is different physically and psychologically than most other seven year olds. I can't deny that, but he is still my seven year old, and despite acknowledging all of these differences, I told him he is very special, that going through this will make him stronger, and that none of his other friends can say they survived cancer. Nor can they say they have bionic parts. I told him that when these parts start fully working, his friends better watch out. With that, he started to laugh. However, this subject matter came up in the car ride home as well. It is firmly in his mind, and despite trying to help him manage these feelings, it is heartbreaking to hear your seven year old say he doesn't like himself. I realized for the first time, or maybe accepted it for the first time, that osteosarcoma will be something I am fighting all my life. Not just physically, but I will be fighting its long term psychological effects. That alone was a daunting proposition. I can see as we get further out of treatment, the mental and emotional anguish that Mattie survived through is slowly being revealed. Certainly I could brush that under the rug, and try to deny it and move forward. But whenever you deny something, it only is going to fester its ugly head somewhere else. So we might as well attack the problem head on. I also realized that my desire to keep Mattie protected from others in the cancer community, meaning not attending camps designed for children with cancer, is a bad idea. He needs to see others like himself, living and thriving. Mattie certainly has wonderful friends, but he can't keep up with them right now, and a part of me always feels on these playdates that in a way it is unfair for his friends. I land up feeling like we are some sort of charity case, which I am sure is not how others feel, but I fully admit my own insecurities. I certainly embrace typically developing children interacting with children who have special needs, but I also must understand the importance of making Mattie whole and accepting himself. Until he does this, he will have a hard time integrating back into mainstream society. So I guess his comments to me were a revelation today, and one that will have to force me out of my comfort zone in order to explore other options for him that will help him develop socially. I think he needs to process his feelings (well of course on a child like level, most likely through play and activities), but the only true way to do this is with other kids who have experienced similar issues.



I am happy to report that Mattie had a very positive session with Anna and Cathy. Cathy will be working with Mattie on days that Anna is unable to. Cathy also has a lot of energy and is very patient with Mattie. Anna and our social worker, Denise, devised a behavioral reward chart for Mattie this week. He can put stickers next to each category he successfully achieves or attempts to achieve in physical therapy. If he accumulates enough stickers, then he will win a prize at the end of the week. The prize he has his mind set on is a rubber ball that sits in the Lombardi Clinic. So I am happy for the moment that this incentive system is working for him. Mattie started the session off on a platform swing, and used "Steve," his right leg to push his body. When you compare his right leg to his left leg, you can see how it has atrophied. However, Mattie really made great efforts today. In addition, he brought in some waxed sticks called bendaroos that he got from Ann, and he used them in therapy. He actually stuck these sticks to the walls and had to use his arms to reach up and place them in front of him. Anna carried Mattie to the wall. But the therapists were amazed, because Mattie put his back to the wall, and literally used it as a brace to start walking. Anna commended Mattie, because she said that is an excellent way to start moving around. That alone was amazing, but the next thing caught us off guard. Check out the photo of Mattie placing the bendaroos on the wall. Do you notice how far up his arms are reaching. Both arms, not just the left arm! I was shocked, because he keeps his arms close to his sides, but in all reality this shows me when pushed how much he can really do! This to me was a very positive step!

Mattie even went on a scooter today and had to push himself up a ramp using only "Steve." He was quite successful, but by the time this was over, he seemed worn out. Pictured in the photo are Anna, Mattie, and Cathy!




When we got back from his session, Marisa came over to help me with Mattie for a couple of hours. Marisa is the daughter of a colleague and friend of mine from the George Washington University. When Marisa arrived Mattie felt nauseous and wasn't in the best of moods. However, Marisa held her own, and by the time I got back, Mattie was playing and seemed to be out of his funk. I am happy that Marisa helped to work this through with him, but leaving Mattie is always a hard thing to do because I never know when he will need me to come home. I certainly wouldn't want anyone caring for Mattie if he was melting down or in need of my attention, this can be hard to manage.

While Marisa was with Mattie, I landed up running around doing chores. It is funny that while grocery shopping I bumped into Dr. Bob and Abigail. They were surprised to see me in their neck of the woods, but the irony is I have gotten so used to shopping near Mattie's schools, that to me this drive is commonplace. But I am sure it catches others off guard that someone from DC would commute to Virginia to shop. One of my main goals today was to go pick up some things at the grocery store to cook for Mattie. Dr. Synder, Mattie's oncologist, is concerned about his nutrition. In fact she has me keeping a food diary for Mattie starting today. So I decided to go shopping and buy fresh vegetables, sweet potatoes, and chicken, and try to cook some of the things Mattie used to like before he got sick. His stomach, I have no doubt has shrunk since chemo, and therefore, he must be served very small portions otherwise, he will be completely turned off to food. So far, I am happy to report that he ate a bowl of fresh cooked spinach that I made for him. But I really want Mattie to stimulate his appetite naturally rather than using such things as Marinol. Marinol is a unique prescription medicine that relieves multiple symptoms. The United States Food and Drug Administration (FDA) approved Marinol to treat nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional treatments. The FDA also approved Marinol to treat appetite loss. Health care professionals may prescribe Marinol to help stimulate a patient’s appetite so he or she will want to eat again. But you should know that Marinol is a Marijuana derivative.


In addition, we learned that a preliminary report has come back from Oncotech in California. It has revealed that Mattie's tumor was 80% positive for Vascular endothelial growth factor (VEGF). An abundance of scientific evidence now points to the central role of both angiogenesis (the growth of blood vessels from pre-existing vasculature) in tumor growth and the role of vascular endothelial growth factor (VEGF) in angiogenesis. So if Mattie's cancer come back again, there are two forms of experimental chemotherapies that target VEGF receptors, such as Gemcitabine and Docetaxel. In addition, the analysis showed that Mattie does not have any Kit receptors on his tumor cells, which means that Gleevec (a targeted cancer drug) would not be an effective treatment for Mattie. What Peter and I have come to accept, we don't like it of course, is that there is nothing we can give Mattie NOW other than MTP-PE to try to prevent an osteosarcoma recurrence. So at this point, the best our advanced healthcare system in this Country can offer us is the wait and see approach. Amazing, we can come up with effective treatment regimens for HIV/AIDS and yet we are still in the dark ages with cancer. Why is this?

We want to thank Nicole Lucarelli for a wonderful and very generous dinner tonight from Papa Razzi. In fact, Peter and I ate outside while Marisa was watching Mattie. It was nice to eat for a bit and be able to talk with Peter about various things today.

I would like to end tonight's posting with a message from my friend, Charlie. Charlie wrote, "Mattie is at that difficult age where he has the ability to decide whether or not to cooperate but he isn't old enough to be able to see past the immediate situation to the distant outcome. I think that just like the chemotherapy, you are going to have good days and bad ones with this. I believe the key will be to find some sort of immediate (within an hour or two) reward that Mattie is willing to work for. Mattie is also intensely competitive so perhaps a chart of his progress where you can mark some daily measurement might be useful? I think that the prospect of getting a "zero" or going backwards on this might be enough to motivate him on some in-between days.I do think that the public has no understanding of how having a life threatening or chronic disease affects your life but your blog is certainly a good chronicle of how that works. Loss of privacy, personal space, little to no sleep, lack of routine, emotional and physical isolation, and tolerance for previously unacceptable behaviors from others, the list could go on for a page. Not only is there no protocol in place for what to do when there is no current evidence of cancer, there is no roadmap or support system in place for the family of a cancer patient either. In both cases, it is a set up as you go system. Not exactly what you want if the desired result is the long term healthy survival of the patient and the family. I hope your blog results in improved plans for both post cancer treatment and family support by the institution."

July 6, 2009

Monday, July 6, 2009

Monday, July 6, 2009

Quote of the day: "Survival is a form of resistance." ~ Mendel Le Sueur

I began my day by receiving this lovely picture in an e-mail from Carey, a fellow Osteo mom. Carey and I have never met each other, but we became acquainted with each other through Mattie's blog. Carey's sister follows Mattie's blog and connected Carey to us. Carey has an 11 year old daughter with Osteosarcoma, who was diagnosed about a week after Mattie, in August 2008. Carey and I have since exchanged many e-mails with each other, and we keep connected on the progress of our children. Carey sent me this photograph, because you will notice a young lady displaying the fact that she is wearing a Mattie Miracle wristband. I introduce you to Alexandra, Carey's niece. Next to Alexandra, you will see a cute girl with a white hat looking at her cousin with a big smile, this is Lauren (who has osteosarcoma). Alexandra purchased a Mattie wristband and we deeply value her whole family's support. Alexandra lives in Maryland and is a high school senior. Alexandra had her own host of medical issues to overcome when she was younger and I have no doubt this gives her insights into children who are living with serious medical issues. Alexandra just got back from an exchange program in the Netherlands, and apparently wore her Mattie Miracle wristband and spoke about Mattie there, so the message about osteosarcoma is getting around. Thank you Carey for passing along this wonderful photo and for sharing this hard journey with us.

Mattie had a rough night of sleep on Sunday. He was literally up every two hours. Mattie complained about everything from pain to nausea. By 6am, I couldn't take it anymore and gave Mattie more pain medication. He finally went back to sleep, and slept soundly! I woke Mattie up this morning so he could eat and then get ready to head to clinic. That went smoothly, but when I got to my car, I realized all our hospital boxes and supplies that we keep in Peter's car, were still in my car. Peter transferred them to my car on Friday, so we could take his car on our road trip for the weekend. So before I could load Mattie into the car, I had to unload our car, and repack Peter's. One thing became very clear to me, we not only have a ton of stuff at home, but we have a mobile unit right in the back of Peter's car. Literally I could set up camp with the supplies we have stored there. This certainly makes sense since we lived out of these boxes and supplies during 11 months in the PICU. So we have two lives to contend with and to clean out. Our home life and our car/mobile life. Wow, that was a little too overwhelming for me today to face.



When we got to clinic, Mattie played with Jenny for a while. He was motivated to continue working on his Hope Fountain or Waterfall as he called it today. I included a photo of how the fountain was transformed today into a jungle theme. You can see green construction paper representing grass, tube like structures representing palm trees with a yellow monkey climbing between the trees, the actual bluish water of the hope fountain, and of course these huge bugs that have made this jungle area their home. The yellow structure in the lower left hand side of the photo represents a bee hive! There is something for everyone in this creation! Mattie spent a great deal of time on this, and then of course wanted to play with the set he created.


It was fascinating to watch Mattie transfer his demanding behavior from me onto Jenny. He had Jenny jumping, and Jenny had other children to balance. Peter and I have talked about the need to reinsert more discipline into Mattie's life. This was impossible to do when he was so sick, but now that we are trying to establish a more normal life, Mattie needs a better understanding of boundaries. He needs to learn the art of being patient, of playing by himself, and the need to respect our decisions. Today actually transpired a bit different from how I thought it was going to go. After several weeks of receiving MTP-PE and having a negative reaction, this was the first week in a long time, where Mattie had NO reaction what so ever. I was unprepared for this, but of course ALWAYS welcome it. However, Mattie was very belligerent in clinic. He gave Dr. Synder, his oncologist, a hard time. He kicked her, and smashed her hand against his wheelchair multiple times. There was a level of anger he was expressing, and during these moments of frustration, he was unable to use words and express himself. But Dr. Synder did not give up. She finally got Mattie to use words rather than physically hurting her to express himself. In fact she wouldn't let him leave the room until he used words. She was a brave soul, because it wasn't easy to sit there and get hit. Dr. Chahine, Mattie's lung surgeon, also came by to examine Mattie's incision. That did not go well either. Mattie did not want Dr. Chahine touching him, and all he kept saying is he doesn't like doctors! Fortunately Dr. Chahine did not take it personally. Mattie's incision is healing beautifully and Dr. Chahine feels that Mattie can start putting pressure on his arms next week. Wow a month goes by quickly!



The real issue for the day though was physical therapy! Mattie gave Anna an amazingly hard time. He shut down and did not want to do therapy. He said it wasn't fun, and he did not want to do it. As usual he claimed to know better. Perhaps I should let the therapists take over at that point, but I feel as a parent it is my responsibility to correct and direct Mattie. I wasn't going to let Mattie talk himself out of therapy. We talked about how therapy may not always be fun, it will be work, but this work is necessary to walk and get better. I told him if he wants to go back to school and play with his friends at school, he has to be walking. Anna had Mattie standing for 15 minutes on both of his feet. He actually was very uncomfortable with this, and then started complaining that his right foot hurt. But I kept reminding him that his foot is no longer fractured and he can put pressure on it. I frankly wonder how other children do therapy without their parents involved in the session. It must be great for them, but for me, I feel the need to play an active role, otherwise with all of Mattie's back talking and attitude nothing would get accomplished. Mattie really refused to do therapy today, and then called me his boss. I corrected him and told him I am his mother, and as his mother I have to look out for his best interest, even if he perceives what I am asking him to do is not fun. He then proceeded to tell me I was a bad mom. What you need to understand is this whole conversation is happening in the middle of the clinic, where everyone can hear what is going on. I have become so desensitized to discussing sensitive issues in front of people this year, that I really did not care who was listening. But I can assure you I have come a long way, since I would have been mortified by this dialogue in public back in August 2008. I finally told Mattie I wasn't going to argue with him, but if he decided not to do therapy, the only person he was hurting was himself. Anna really worked hard at being flexible and approachable with Mattie. Anna did get Mattie to kick a ball several times today with his right foot, but it was like pulling teeth. After hit the ball several times, he broke down into tears. So needless to say this was a therapy session that was very challenging. Challenging because Mattie wouldn't meet us half way and participate in the process. We shall see what tomorrow holds as we head to the physical therapy clinic, rather the pediatric HEM/ONC clinic for a session. This is one of the many challenges of dealing with a young child with osteosarcoma. It is sometimes hard to rationalize with a seven year old about the importance and nature of physical therapy. All he can think about is pain, being controlled by someone else, and that it isn't fun. An older children may feel this way too, but I think they would also understand the importance of buying into the process.



At 5:30pm, we left the clinic, and Dr. Synder practically walked me to my car. It was the only way I was able to discuss Mattie's blood work and next steps with her. Mattie wouldn't give me a minute in the clinic to myself, and since Jenny and Jessie (Mattie's art therapists) had previous commitments, I was balancing Mattie alone. Dr. Synder landed up helping me with my purse, cleaning things off my face from clinic, and I started laughing. I said to her I must look like I am in need of a lot of help.

So with regard to next steps here is what we know so far. Mattie is headed for an echocardiogram on Thursday morning. We are trying to assess if his heart has really been impacted by chemo, or if over time it has repaired itself. About a month ago, Mattie's echocardiogram indicated a reduced LVEF (Left Ventricle Ejection Fraction - 51%), which in layman terms means that his heart is not pumping with its normal level of pressure. Dr. Synder wants to assess his LVEF this week, and from there will determine whether he will get two more doses of Doxorubicin (one of the chemo drugs he received before). What surprised me is she has tentatively scheduled this two day infusions of Doxorubicin for next Thursday and Friday, but in the clinic. So we wouldn't be doing this as an inpatient in the PICU. Certainly I am thrilled we can go home each night, but a part of me will miss the opportunity to see our HEM/ONC nurses in C52 that we have become so fond of. If Mattie's LVEF remains the same or decreases further, he will be ineligible to receive these two doses of Doxorubicin. So we will know more after Thursday's echocardiogram. Peter and I debated back and forth today about next steps. You need to understand that there are NO next steps, or at least NO known and well researched next steps for a patient like Mattie (Can you believe there is little to no data out there about how to treat a patient who has had osteosarcoma removed from the limbs and then the lungs? What I am saying is there is no research about a maintenance plan or how to treat this horrible disease prophylactically, when there is no evidence of further disease.). He technically has no evidence of disease right now, so there is no trial or drug to ethically give him. However, Dr. Synder is recommending that we scan Mattie every two months rather than every four, and plans on consulting with Dr. Bob to see if he is amenable to having Mattie's previous surgical sites scanned every two months as well. We are still awaiting results from Oncotech, which may enlighten us further about the receptors present on one of Mattie's lung tumors.

We want to thank the Chiaramonte family tonight for a wonderful dinner. Mattie loved the pasta and apple pie. I am happy to report that Mattie is eating a bit better and is drinking milk like it is going out of style, which is excellent. I had several conversations with Ann today, and she is being very proactive to make sure Peter and I celebrate our anniversary next week, as well as my birthday. I remember my friend Lisa wrote me a few weeks ago and reminded me it is important to celebrate my birthday. That Mattie needs to see this normalcy. The way I feel, my birthday could come and go, and it could be any ordinary day. In fact, Mattie was diagnosed two days before my birthday last year, a day I will NEVER forget. However, clearly Ann and several other Team Mattie supporters are focused on making this year a better one for me, and that includes getting together to celebrate my birthday. In a way it is very, very touching that Ann and others care this deeply. I am not used to having so many people caring for me, but I have found that in allowing this to happen I have developed some beautiful friendships.

I end tonight with a message from my friend, Charlie. Charlie wrote, "I am glad you got your break but sorry it wasn't everything you hoped it would be for Mattie or for yourselves. Although it is difficult, I think you are going to have to find a way to make more deposits in your "emotional bank account" even if they are very small ones (i.e. short amounts of time). What you are facing is almost akin to a prison camp situation and is about personal survival until Mattie is really on the path to healing and wellness. You need to work at protecting yourself as well as Mattie since his survival depends on you. I know that Ann and the other members of the Mattie team will understand and do everything they can to support you in this process."