Accessibility barriers at M.D. Anderson

OK, now I’m pissed. I went to the “MyMDAnderson” Web site to check my schedule for the next couple of weeks. It’s a good idea—a secure site where you can check appointments, request schedule changes, send secure messages to members of your care team, even look at your billing information.

But there are a few annoying accessibility barriers. For example, none of the pages on the MyMDAnderson site (or the rest of the MD Anderson site) uses HTML heading markup. Yet there are clearly places where such markup is called for—specifically, pictures of text that identify the beginning of the primary content on the page. These pictures of text have alt text (as required for any image) that contains the same text as what
Is shown in the image. So what’s the problem? The problem is that I can’t use the tools built into my screen reader that would allow me to navigate directly to those headings (that’s what I’d be able to do if they were marked up correctly). So I can’t get a good overview of what’s on the page and how it’s organized.

Also, there is no mechanism for bypassing the large blocks of repeated content that appears on every page—such as navigation links that may run across the top and down the left side of the page. So I have to listen to them all, right down to the links at the bottom that are required for all state organizations. Only then do I get to hear what I came for.

Both of these issues are easy to fix. In fact, marking headings correctly would also fix the second problem, since screen reader users could then jump directly to the appropriate heading. This would save at least 40 seconds per page!

When I finally did get to my appointment list, I discovered one that I’d sort of like to change. So I selected the handy “Reschedule” link. This took me to a form where I could send a message to Dr. Andersson’s scheduler. In theory, that is. Only problem was that the field for the actual message wasn’t labeled—other parts of the forms were labeled (or at least JAWS was able to guess). But I couldn’t find the place where I was supposed to type in my comment.

Enough already. I found a link called “Feedback” and figured I’d send a comment to the Webmaster. This time I was able to find the comment field, so I was happy, or at least happier. I wrote a careful comment, describing the problems discussed above and providing a link to the Accessibility Institute’s How-tos and Demos page, where techniques for addressing these problems are documented. I was just about to write that I would be willing to discuss the issues with the Web team, when—poof!! Up popped a message that said “timeouts expired,” and the damn thing logged me off! (“Timeouts expired” is jargon for “you’ve been here too long and we’re kicking you out.”)

Here’s the message I got:

Monday, July 24, 2006

Time Out/Page Expired Notification

You have been logged out of myMDAnderson because you haven't requested a new page in the last 20 minutes or have already logged out and are trying to view a page in your browser's history. To access your personal information, please login again using the menu option on the left.


I don’t remember seeing/hearing anything anywhere on MyMDAnderson about time limits. This is an important accessibility issue—not just for me and other patients or caregivers who are blind, but for any cancer patient who  may have peripheral neuropathy in the hands, anyone who may be unable to type quickly, anyone who has cognitive limitations that may make it difficult to complete online transactions quickly. We spent a lot of time on such issues in Web Content Accessibility Guidelines 2.0 (see especially Guidelines 2.2, which is about timing; and Guideline 2.5, which is about minimizing chances of error and making it easier to correct errors that do occur).

So I’m pissed. The MyMDAnderson site is supposed to provide a convenience for patients, a way to track important things without having to play phone tag with the extremely helpful but extremely busy humans who are juggling many other people’s needs in addition to mine. But instead of being a convenience, it became a time-sink and got me all riled up on a day that started out just fine! I got a decent night’s sleep, I felt good and strong when I woke up, I took my time showering and getting dressed and feeding and walking and grooming Dillon and eating the lovely breakfast that Anna had prepared for me, and then I sat down at the computer to do something that should have taken 10 minutes, tops, and instead God only knows how long I’ve been here.

MD Anderson is a state agency. It’s also part of the University of Texas System. On both counts, it should comply with published accessibility standards. Interestingly, there doesn’t seem to be a link to an accessibility policy (at least not on the “Timeouts expred” page), and the term “accessibility” doesn’t show up on the “Legal statements” page.

I wonder what percentage of the thousands of patients who move through the corridors and clinics of MD Anderson each day would qualify as at least temporarily disabled? Certainly a great many are very weak, and would have a hard time walking up a flight of stairs or walking a city block without having to stop and rest; some may be experiencing cognitive impairments as the result of chemo or radiation treatment or the cancer itself; some may be experiencing changes in visual perception for the same reasons; some may have neuropathy that makes it difficult to type quickly or accurately.

I was OK till the timeout expired. That was the last damn straw. Insult to injury, yatta yatta yatta.

From Anna: Two invitations

Anna asked me to invite your involvement in 2 special ways:

1.  130 Letters

A project we're calling “130 Letters for 130 Days”.  We are requesting from you and/or others a total of 130 (or more) letters or small packages (which will be placed in brightly colored envelopes numbered randomly from 1-130).  John and Anna can open 1 each morning of the bone marrow transplant process starting mid-August, and we’ll read the contents to John.  These “letters" can have any contents of your choosing--poems, small  good luck items, an email sent to dianec@interactiondesign.com, or an envelope sent to 130 Letters c/o Diane Colvard, 405 East 35th Street, Austin, TX 78705 (Anna doesn’t want to peek as they will be a gift to her as well).  If we receive more than 130, we'll open more than one on some days.  Diane Colvard will coordinate and can be reached at 512-796-0841 or 512-442-9400.

2.  Event in Austin:

Please join us for a special love-fest ritual to honor John Slatin (along with Anna Carroll, tender lovin’ caregiver) & to wish John a successful bone marrow transplant & renewed health!

Sunday, August 6th, 4-6pm
First Unitarian Universalist Church of Austin, Howson Hall
4700 Grover Avenue

          Music and ceremony will include LZ Love, gospel artist, interdenominational ritual, offering of your spoken wishes, collection of “130 Letters for 130 Days” (you are invited to bring a message to place in a randomly-numbered envelope & to hand it to John and Anna at the ritual), & more!  Music starts 3:45, Ceremony at 4pm

Beverages and appetizers served
Dress: August-day, Austin-eclectic celebration attire
Letters from out-of-town friends & family also welcome at the ritual

Information re: transplant process, how to find to Rotary House/MD Anderson, contact to coordinate visits, etc. provided
  
Please RSVP to Diane Colvard: dianec@interactiondesign.com, 796-0841 or 442-9400

Directions: Take Burnet Road to 49th Street (where it branches onto Woodrow by Omelettry)
Go east (toward Lamar) on 49th to Grover Avenue—about a block
Right on Grover, church is where street dead ends

Correction and quick update

Correction: Last night’s post gave two different dates for the start of the transplant process. The correct date is Monday, August 14. (I’ve fixed it in the blog entry now.) Thanks to Dr. Tucker for pointing out the inconsistency.

Dr. Tucker also just performed a lumbar puncture to collect a sample of my cerebrospinal fluid and instaill a dose of intrathecal chemo directly into the central nervous system. Smooth and painless, just the way I like it. Thanks again, Dr. T.     

Transplant process will start August 14

News flash! Last week’s phone calls and emails have borne fruit: Dr. Andersson presented my case to his colleagues in the Bone Marrow Transplant group on Tuesday (day before yesterday); he then spoke at length with Dr. Giles, who in turn spoke with Dr. Tucker yesterday morning. Dr. Tucker then told us when we saw him at noon yesterday; and Dr. Andersson called me late this afternoon to confirm and expand a bit more. So here’s what I know:

The transplant process will begin on Monday, August 14. Sometime during the previous week we’ll need to be in Houston for various tests and other preliminaries. At the same time, my brother Peter will be there having stem cells “harvested” from his blood—an amazing, beautiful gift of love that just plain beggars the word “donor.” Thank you, Peter, thank you. I love you.  Millions of Peter’s stem cells will be infused into me after my own bone marrow has been killed off by another round of systemic chemotherapy. They’ll use a combination of drugs for this chemo: busulfan and fludarabine, a combination they’ve been working with at M.D. Anderson for the past ten years as a “milder,” less risky alternative to older methods of killing off the bone marrow in preparation for transplant—uncluding such methods as Total Body Irradiation, which, thankfully, will not be used in my case. Dr. Tucker says the experience shouldn’t be all that different from the chemo I just went through—minus the diarrhea and the radiation recall reaction, thank you very much!!—but I’ve learned that it’s best not to form too many expectations that my response on one occasion will be like my response on another occasion.  Better to just go along for the ride and keep visualizing the destination. I’ll be in the hospital for a month; we’ll then stay in Houston for at least another 100 days, during which I’ll make daily visits to the clinic as an outpatient for monitoring and testing and adjustment of various drug dosages, for transfusions, and so forth. And then, if all goes well, we’ll be able to come home in mid- or late December.

Both Dr. Giles and Dr. Andersson were at pains to emphasize what Anna and I had already figured out: that there are no data on cases like mine. There just haven’t been any. Andersson can’t remember any in the past ten years. He said there might be one or two if they looked 20 years, but there’s no point in doing that—the treatment protocols in place then have very little in common with the ones in use today. This is frightening—who wants to be this unique?!—but I find it reassuring to have it out in the open. It makes me feel that the process is more accessible to me and Anna: we’ll be working with the doctors, not just being worked upon by them.

There’s lots more to learn, and many details to be worked out about where and when and what. Eric, the Lead Transplant Coordinator, is out of the office this week, and I imagine he’ll have a lot of things to catch up on when he gets back on Monday; I probably won’t know much more until late next week.

Meanwhile, I’ll have weekly “maintenance” doses of chemotherapy to the spinal fluid, which means a weekly lumbar puncture; the first one is scheduled for tomorrow afternoon in Dr. Tucker’s office. I’ll continue trying to build my strength while we do our best to plan; and of course we’ll continue to see our friends and soak in all the wonderful energy coming from so many wonderful people.

More soon.

A week at home!

Sorry it’s been so long since my last post!

I’ve been at home for a week now, and it’s just wonderful. I’m still weak and I get tired pretty easily, but I’ve been gaining strength every day and feeling better. I’m scheduled to see Dr. Tucker again the day after tomorrow, but haven’t been to the clinic since last Thursday. My neutrophyll count was well into the normal range then (it was 4.7), and while both my hemoglobin and platelet counts were still low, the platelets had started to come up, indicating that my body might have made some platelets on its own, and that indicated that the hemoglobin count would probably start rising as well (with a little help from the Aranesp shot I received on Wednesday afternoon—the red-cell counterpart to the Neupogen shots I’d had the last 6 days in the hospital). I’ve felt well enough to go out with Anna for a couple of dinners, and yesterday morning we went to BodyChoir. I didn’t dance—just lay on a mat at the front of the room, near where Anna was playing the music she’d selected for the dance. (The music was gorgeous; she played a Portuguese fado near the end that just broke me open, not just with sadness and grief at my own situation but with joy for all the beauty and love that filled the room.) So I lay there with Dillon, and throughout the morning people came over to pet both of us (<grin>); by the end of the dance I could feel and hear a lot of people around me, holding me, holding each other, and then the breathing turned into a wordless chanting, beautiful and deep and soothing.

Friday afternoon Anna took me over to Elke’s, to talk about nutrition and other things that will help me rebuild my strength and reduce stress levels as I prepare myself for the bone marrow transplant (more about that shortly). She began by doing some “muscle testing”—she had me press the fingers of my left hand on acupuncture points at different places in my upper body, while at the same time I joined the tips of my right thumb and middle finger and tried to resist as she tried to pull them apart. In each case she was able to break my grip very easily, meaning that each of the acupuncture points she was testing was “off.” Then she put four or five small vials into my pocket, and we repeated the procedure; this time, to my amazement, I was able to resist when she tried to pull my thumb and middle finger apart. I have no idea how that worked. Elke explained that it had something to do with a “resonance” between the frequencies of the materials in the vials and the frequency at which my body resonates. I don’t understand this, but there’s no gainsaying the difference between the first round of muscle testing and the second. The vials contained various supplements—minerals, etc.—and we’ll talk about them with Glenn Leupnitz, an extraordinarily knowledgeable nutritionist who works out of an oncology clinic, tomorrow. Meanwhile, we’ll go to Elke again late this afternoon. The most amazing part of Friday’s session was what followed the muscle testing. Elke described it as acupuncture without needles, but there’s more to it than that. After using some kind of computer-linked sensor to get a reading of various acupuncture points, Elke put some headphones over my ears and some glasses over my eyes, then inverted the chair so that I was almost upside down. She flipped a switch somewhere (presumably on the computer), and three things happened at once: in my ears I heard the sound of waves breaking on the beach, as it were “behind” pulsing electronic sounds—not music exactly, just a range of frequencies including some very deep bass tones; the chair vibrated in tandem with the bass notes; and I saw flickering red light behind my eyelids (Elke had explained that this would happen and that my blindness wouldn’t affect it since everyone has their eyes closed at this point). The sound of the waves was wonderfully right—Elke had suggested that I visualize someplace where I had been happy, and my mind turned immediately to Cape Cod, so the wave-sounds were just perfect. My mind strayed to other things, but apparently I didn’t get far from the Cape. At one point I found myself visualizing Fisher Beach Road in Truro as one would walk toward the beach—a beautiful vista of tall grasses, blueberry bushes, shingled houses, and Pamet Harbor off to the right. But then suddenly I must have been walking the other way,  because I was turning right from the roadside into the sand driveway of the cottage my family rented for several years (the Anderson cottage, I think it was called). And there was Smokey, the Lab-Something (beagle, maybe?) mix whom we’d rescued from the pound when I was in 8th grade, wagging his whole body, grinning and sneezing, happy that I was home. He clicked into view like a slide in an old-fashioned slide projector. “There you are!” I said to him, delighted to see him. And suddenly I was crying, because I realized I hadn’t said good-bye to him properly—he died of a heart attack one night during my first year in graduate school, and I was so preoccupied that I didn’t really allow myself to feel anything when my father called to tell me the news. And then I was happy again, thinking that Smokey and Dillon would have liked each other and had fun together. And then my mother appeared; I could hear her bracelets jingling and saw the one-piece bathing suit she was wearing (I think she may have made it herself). She was happy—she loved it on the Cape—but didn’t say anything. I was glad to see her—she looked so young! (This would have been sometime in the mid-60s, I think, and she’d have been in her forties; she was young!) Then I was aware of myself in that chair, almost upside down and crying, wondering happily at those amazing images, astonished that they had appeared. The session ended, Elke brought me upright, and I was back in the room with her and Anna and Dillon. That night I slept better than I had in weeks, maybe months.

The previous afternoon, on Thursday, Anna and I had an hour-long conference call with Dr. Andersson, the transplant doctor from M.D. Anderson. The call was arranged by Donna Martin, the Patient Advocate—we had been feeling increasingly caught in the middle between Dr. Andersson and Dr. Giles, the leukemia specialist who’s been treating me since May, because they seemed to have quite different ideas about when it would be appropriate to begin the transplant process—an issue Anna and I don’t feel competent to  resolve--and as far as we could tell the two hadn’t spoken to each other. At the end of my last visit with Dr. Andersson sometime in May, he had suggested that we meet again in late September, because he wanted to see evidence of remission in the Central Nervous System (CNS) for 4-6 months before beginning the process. But when I mentioned this to Dr. Giles, he said, “That’s a tall order!” I asked him then to talk with Dr. Andersson about it, but as far as I know that hadn’t happened. After the fact, I realized that I took the “tall order” comment to mean that Giles thought it unlikely that I could stay in remission that long. That makes me anxious all by itself, and it made me increasingly anxious about waiting till late September even to talk with Andersson again.

It was a good call: Dr. Andersson both explained the reason for his wanting to see a 4-6 month remission and agreed that it might be a good idea to begin the process in late August or early September after all, which is the timeline Dr. Giles had mentioned during our last meeting with him as well. He explained that the 4-6 month figure is a kind of informal policy at MD Andersson, which has come out of past experience: patients who underwent transplant while not in full remission had done poorly. My CNS has apparently been leukemia-fre since early June; a late August or early September start might be OK if all the preliminary tests yield the right results.  Dr. Andersson will be presenting my case to his colleagues in the transplant group today, and he agreed that he would speak with Dr. Giles soon afterwards.  So I’m hoping for some news later today or tomorrow.

Anna and I told him during the call that we had been wondering about the necessity for the transplant. By all accounts it’s a long, grueling, difficult, and risky process. My bone marrow was apparently clear as of mid-May, so I’ve been in remission there for 10 months. The spinal fluid is apparently clear, too, as of June 9, when the last sample was taken and I received my last, 6th, dose of intrathecal chemotherapy.  Doing the bone marrow transplant, Dr. Andersson confirmed (as Dr. Giles had said previously), will not “cure” the leukemia in the CNS. So why do it ?

What it comes down to (and here again I think Drs. Giles, Andersson, and Tucker are in agreement) is that the relapse in the CNS is a sign, a “harbinger” in Dr. Andersson’s words, that a systemic relapse, a relapse in the bone marrow, is inevitable now: as Andersson said, it’s not a question of if anymore; it’s a question of when. The transplant—killing off my own damaged bone marrow and replacing it with Peter’s healthy stem cells—is the best hope for establishing long-term remission. But if I have another CNS relapse during the transplant process I will be in deep, deep, deep trouble: I’ll have virtually no platelets, meaning that my blood won’t clot, meaning that they won’t be able to do any intervention that might cause bleeding, such as implanting a catheter or performing a lumbar puncture. So the CNS remission needs to be solid in order to proceed. So there are delicate balances to be struck: Dr. Andersson said repeatedly that the first concern is to be as sure as possible that the treatment itself will not harm me. I’m grateful for that concern! And of course I know it’s shared by everyone involved, and I’m grateful for that as well.

As I said earlier, Dr. Andersson was hoping to present my case to his colleagues in the BMT group today (it’s Tuesday evening as I write now), and then I hope he has had a chance to speak directly with Dr. Giles. I haven’t checked email yet to see if there’s any word from him or Dr. Giles.

The phone call, and the follwup email I sent to Dr. Giles et al. the next day summarizing both the call and my experiences of the last couple weeks, and raising several questions, were a big deal for us. For me, I think, the call and the email were extensions of my recognition that I need to take a much more active part in my own treatment and recovery, and an outgrowth of a very powerful session with Bhagirit while I was still in hospital, when we talked about how to empower ourselves, about the things we could do. I’ve also been reading a book called The Patient from Hell (actually JayByrd has been reading it to me a couple of chapters at a time); it’s by a Stanford researcher (global climate change) who had lymphoma, and both chronicles his experiences and explains how he and his wife worked to ensure that his treatment was optimized, indivualized to his specific situation. I’ve learned a lot and taken heart from it, though his descriptions of the preparations preceding his own bone marrow transplant fill me with dread. The good news of course is that he’s still alive five years later, and I keep hearing from other people stories of friends and relatives who’ve been through the process and gone on to long, good lives. Those stories are precious to me: I am learning to visualize the transplant as a phase in a much larger process, and learning, too, how I can use my own strength to make the process work well.

But it’s not like everything is hard and grim all the time. Many, many people have visited, often bearing food: thanks to Wick Wadlington and Elizabeth Harris, Ivana Slavnic, Anna Sergi, Celia Hughes, Brian Bremen, and everyone else I’ve forgotten to mention. Sue Heinzelman came over on Saturday morning and cooked breakfast!, and then we had a lovely conversation. There have been other great conversations, too, both while I was in the hospital and since I’ve been home. It may sound strange to say this, but those conversations have been a gift, an unexpected positive side-effect of my illness. The world has slowed down, or at least my world has, and space for conversation has opened up. I want to find ways to continue that, to disentangle it from the illness and reintegrate it into “normal” life (not that life will ever be normal again; I mean Life After Transplant).

I’m going to stop now and get this posted or it’ll never happen. Then I’ll check email and go to bed. Thanks again to all of you for thinking of me and for your love and prayers. You make me strong.

Im outta here!

I’m outta here! I’m being sprung later today—not sure when: after a transfusion of platelets and another of red blood and after they take out the PICC line; my guess is it’ll be sometime this evening, but I don’t really care. What matters is that we’re going home!!

The Neupogen shots (yesterday was #6, I think) finally kicked in last night. I had a little twinge of pain in my lower back/kidney area when I went to the  bathroom, and got worried—what if I’m developing a bladder or kidney infection just when things are starting to look up? But then I remembered that particular kind of pain: this would be the Neuopogen! And it was. The night was a bit uncomfortable (but nothing like the way I felt after the Neulasta shots last fall), but I was happy: the white count would be higher in the morning, I knew, and so it was.

--Update, 7:15 PM, Monday 3 July
Almost there now! I’ve had two transfusions today: a unit of platelets and a unit of red blood cells, with a dose of IV antibiotics in between. All done now. The line is being flushed with saline. When that’s done the PICC line will be removed from my arm (doctors Turner and Bissett are still concerned that it’s infected, and that without the IV antibiotics I’ll get sick all over again). And then there will be some paperwork, of course, and then we’ll get the hell out of here and go home, home, home!!

Again and again—I can’t say it nearly often enough—thank you to everyone who’s called and visited and brought beautiful food or been so present with me, thanks to everyone who’s been with Anna to keep her company and help her do what she’s needed to do to help me; thanks to everyone who’s sent good wishes and prayers our way; thanks to BodyChoir for including my name in the closing circle.

I’ve got a lot of email to catch up on; thanks to everyone who’s taken the time to write, too. I may not be able to respond to all of you, but I treasure your  messages.

OK. That’s all for now. I’m going to pack this up and send the post when I get home.

The journey continues!!

Out of isolation! (from 1 July)

The good news is: no more isolation procedures! This means that people can enter and leave my room at will, without having to don spacesuit-like yellow paper robes and surgical gloves, and I’m allowed to leave the room myself (not that there’s anyplace very exciting to go). In other words, the diarrhea that brought me here two weeks ago today is pretty much gone (yes, it took a long time!), and that’s really good news. Thanks so much to Anna for thinking to ask Dr. Bissett, the Infectious Disease doctor (why do I want to put that in caps?), when I could be taken off The List! He said, “I’m making a bold gesture!” and yanked off his gown. That was fun, and funny, and we had a good laugh. The bad news is that we’re still here at Seton Hospital because my white blood count is still bottom-crawling—it’s been bouncing between 0.1 and 0.2 for the past four or five days, and the neutrophyll count (not just the white count) has to hit 500 and show a clear upward trend before Dr. Tucker willfeel that he can safely release me on my own recognizance. I’m shooting for Tuesday—it will be fitting to be released on Independence Day!

IQuick note from later in the day: Kunday came by a little before 4:00 with the news that it was getting cooler outside, wind was rising, and it was going to rain. She suggested we go outside, and since Anna and I had just begun a little walk down the hall with Dillon—my first venture outside the room!—we changed our plans. Someone found my shoes; I put them on over the hospital slipper-socks, remembered that I shold be wearing a mask since I have no immune system, and off we went. Dillon was thrilled—he had gotten very excited when I picked up the harness and slipped it over his head—and when we got outside and sat down on a bit of cement near a fountain/waterfall he stayed very close to me and let me put my arms around his neck and hold him close. I was crying, which is really not a good idea when you’re wearing a mask, but so what? It was so wonderful to be outside. We stayed out about 10 minutes, then came back upstairs; I was exhausted but very, very pleased. Kunda, thanmks for making that suggestion!)


I didn’t have a chance to write last weekend, so I want to mark two things about it here. First, last Saturday we had been due to leave for a two-week vacation on Cape Cod, and I’m very disappointed that we didn’t get to do that, not only because I love the Cape so much and badly wanted to be there, but also because this is the second year in a row Anna’s had to spend her badly needed vacation in the hospital with me, and I’m sad that she hasn’t had the freedom to travel and explore. Now I’ve backed myself into the second thing I want to mark: last Sunday was the one-year anniversary of my AML diagnosis. I’m so thankful to be alive. I had to stop for a minute after that sentence—it took my breath away, brought tears to my eyes, and I just couldn’t continue. What a long, impossibly short, terrible, beautiful,ugly, wondrous, utterly amazing year it’s been, and continues to be.

Elke reminded me earlier this evening to visualize what comes after the bone marrow transplant: full health, dancing at BodyChoir, talking with friends, working, enjoying the full taste of meals, traveling… And suddenly I was right there, seeing it and feeling it and tasting it and grinning; even my voice was stronger. I have been caught up in imagining the worst moments of the treatment instead of focusing on the outcome, the point of the treatment: to be well. It sounds self-evident when I write it like that, and maybe it is; but I had lost track of it for a while there, and I’m very grateful to Elke for the reminder. It goes along with the material that came up yesterday in an energy session with Bhagirit, which in turn dovetailed with what JayByrd had been reading to me the other night about going to the spaces that scare us, about groundlessness, about discovering myself there, in those scary places, still standing, OK. I thought of Frost, in poems like “Mending Wall” and “Birches” and “The Wood-pile” and “The Road Not Taken,” coming again and again to the imperative to choose, to take some action, when there is no basis for choosing. The lines of tall slim trees in “The Wood-pile” are too much alike to mark or name a place by, so as to say for certain he was here or somewhere else; there’s no need for that stone wall he and his neighbor rebuild each year in “Mending Wall,” no visible difference between the road taken and the other one—no difference except the ones made by human choices grounded only in the need to choose. I haven’t read those poems for years, though I’ve thought of them often; they come now as beautiful, terrible, clear, the  place that scares me, myself in my need to choose.

I need to gather myself for the journey. Fortunately, I have time to prepare—a couple of

Still no network access. Will have to figure out how to post this, or else just wait till Monday and ask Diane to do it again for me, the way she did the last one I sent. We’ll see.months to eat well, to exercise, to begin practicing meditation, to look toward the future from within the here and now, to visualize good things happening within my body right down to the subatomic level—the terrible light of radiation doing its work to melt the tumors in my brain, the chemotherapy rooting out any lurking leukemia cells in the bone marrow since my own immune system is no longer capable of that work. That’s my work over the next couple of months and beyond. I’m being helped along the way by many, many people. It’s truly awesome. Thank you, thank you.