Recently, I visited family in San Francisco, my hometown. My roots are urban, but 40 years ago, my wings carried me to more rural environs. I was born at Children’s Hospital on California Street in 1946. My parents worked hard providing their five kids with the basics: bikes, baseball mitts, and a safe home.
I have three brothers and one sister. All of us siblings pursued middle-class careers: fireman, utility worker, airline employee, librarian, and postmaster. We inherited our blue-collar work ethic from Mom and Dad. My father was a body and fender man at an automotive dealership. My mother worked decades as a nurse, often choosing swing or graveyard shifts in order that we kids would have at least one parent home for meals.
My last sojourn to the city occurred in May of 2010 when my son graduated from the Berkeley School of Law. Prior to that, I visited in June of 2008 just before embarking on my stem cell transplant for multiple myeloma at the Seattle Cancer Care Alliance. My sister precipitated this year’s mini-reunion. She works for the Milwaukee Public Library in Wisconsin and chose to vacation in San Francisco.
I am the youngest of the boys. My brothers all live in California. My sister and I live out of state. On my periodic visits, the family always convenes at my brother Tom’s house. He and his wife live atop Stanyan Street on the slope of Sutro Forest. This is one of the few places in the city where you receive nightly visits from raccoons, opossums, and a revolving door of homeless cats.
Their dining room on the third floor provides an expansive view of neighborhoods stretching northeast toward the bay. On many afternoons, fog creeps forward. It mutes the city’s hubbub and spikes the air with a blend of the ocean’s salt smell and the pungent aroma of eucalyptus from the adjacent forest. An opaque shroud covers the houses below, hiding intersections clotted with traffic.
In spite of my origins, I’m something of a country bumpkin when revisiting the city. What I used to take for granted now awes me. How, I wonder, does its frenetic energy coalesce into order? The infrastructure of a big city is a miraculous creation. An interdependent web of systems designed to accomplish specific goals exists as a backdrop to hundreds of thousands of individuals. Utility workers maintain the complicated networks that power daily tasks; crews devoted solely to handling the city’s waste products keep the streets clean and sanitary. I could go on, but the point is that the whole is greater than the sum of its parts.
In a way, our body mimics the activities of a metropolis. Our respiratory and circulatory systems, for example, just go about their business, independent of any input from us. Our blood flows; we breathe in and out. Another example, apropos to my situation, is the immune system. It is comparable to a police force. When lawlessness, in the form of an invasive intruder, threatens to undermine our health, a SWAT Team of antibodies races to the rescue. In the case of multiple myeloma, which is a cancer of the immune system, the police, unfortunately, are corrupt.
Siddartha Mukherjee, in his Pulitzer Prize winning book, The Emperor of All Maladies, theorizes about this corruption. He alleges that the gene for cancer is inherent in our DNA. Genes are programmed to mutate; it’s an evolutionary imperative. Normally, our body discards unproductive mutations. However, as we age, the more stubborn mutations withstand our immune system’s defenses. Many cancers, certainly multiple myeloma, are age related. MM is generally a disease of older people whose immune systems are wearing down. Mutations also occur in response to toxic stimuli in the environment. Perhaps this explains the seemingly increasing incidence of MM in younger people.
Soon after returning to Oregon, my monthly blood work revealed a small up tick in the numbers specific to multiple myeloma. Dr. M and I decided to add a low dose of steroids to my maintenance chemo. MM does not herald its coming. Like the fog in San Francisco, it slips in quietly. One moment the blood work is clear then, suddenly, things are murky. I’m ok with this little tweak in treatment. I lean toward the theory that these drugs work better in combination than alone. Furthermore, my numbers remain quite low and I feel good.
Good Blood, Bad Blood 
I’m so glad you’re still feeling good. “Small up tick” is not a terribly alarming description.
I was completely involved with your wonder at the way a city operates, as I am having the same country-bumpkin response to San Miguel de Allende. I more or less understand how small towns work (or don’t), but I am fascinated with how one of this size seems so, well, operational. And more than that, San Miguel, like San Francisco, has such a strong personality. How does that come to be?
Probably easiest just to enjoy the wonder of it.
Thanks for continuing to write.
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I suspect that mm appears more in old age is because achieving the two mutations needed to convert a healthy plasma cell into myeloma are difficult to achieve in nature. Long exposure — that is, living a long time — may be needed for this unpleasant miracle to occur. I’m not sure I know how the immune system becomes weaker with age.
I think it’s a comfort on some level that we didn’t get this horror because we ate, say, too many salted peanuts when we were young. We didn’t sniff glue. But to those who don’t have the cancer, innocence is disturbing. If they realize that there’s no explicit cause but living, then it could happen to them, too. They can’t stop doing this or going to that to be protected. Nobody likes luck.
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Sutro Forest looks beautiful! Not something I expected in San Francisco. So glad you are feeling well and that you could get together with your siblings…family means so much to EZ and I. Hope the low dose steroids take care of the upswing in your number. How very true that MM does herald its coming…much like fog. Glad you could jump on it right away. Good to read a post from you again! Take care and keep writing!
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Nice piece, bro, as always. The pictures are great, and even better knowing that I was there with you when you took them! Stay well!
Love, Sis
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SF was a place I stomped around with my children for nearly a decade so it will always be one of my favorite cities. I enjoy very much your description of it.
One of my children is married and is the caregiver for the MM patient, so I’m all too aware of the youthfulness of the attack. And Lonnie’s point is well taken that ‘luck’ (or should it be better defined as the FFF = Fickle Finger of Fate?) is now less age-specific or even race-specific as the disease proliferates. But there seem to be more people who are getting the right combinations of treatments to make it more manageable for longer periods of time. I intend this for you.
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I am glad that you are doing well, John. Your calm and positive attitude seems to me one of your best defenses.
I have never been to San Francisco, although I hope to go sometime soon. I love to travel and there is so much of this world that I haven’t seen.
I completely understand your mixed feelings and sense of displacement about living in big cites. I myself grew up in big cities, but have always been a country girl at heart.
Best wishes to you,
Liliana
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John —
It was great to see you in your “mom and pop” postal store the other day, even though I wasn’t really in the market for any goods. It certainly wasn’t like San Franscisco’s.
Right after I graduated from the University of Texas in 1969 I spent seven very significant years in the Bay Area (Oakland and Berkeley, with many trips to the City).
I couldn’t wait to leave my unsympathetic home state. Oil refineries and chemical plants and fish processing plants surrounded Port Arthur, where I spent my first 21 years. And I remember as a kid chasing trucks spewing DDT out their rear-ends to kill mosquitoes, driving right down my street.
I made my luck after I graduated, but I’m afraid I grew up in one of the toxic places in the USA. Still my brother and sister escaped.
So luck is always a factor. However, I feel that good luck usually goes my way, including meeting fellow travelers at the MM support group. Quality people all, though none writes as elegantly and insightfully as you do. I’m lucky to know you.
David
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As usual, you are thoughtful in the most quietly beautiful way. This is not an easy thing to pull off, and yet you are effortless in your writing.
Complex systems can be so mystifying, and yet also beautiful and effortless in their own ways. I’ve been taking a class in computerized moving lighting fixtures, in order to further my stagehand training and open up more job options, and I can tell you I’ve spent the better part of the week in awe of motors and threaded rods and obscure adhesives and slightly ridiculous trouble-shooting protocols and on and on–with an encyclopaedic instructor, no less–and with all these fixtures can do, and with all we know, there is still So Much We Do Not Know. Which, oddly, I really kinda like — helps with perspective. The moving lights are not effortless at all, really–they’re rather Frankensteinian under the hood in a lot of ways–but they contribute to painting a stage picture that achieves all that is ineffable about live art. Very much in keeping with your thoguhts about the whole and the sum of the parts. (In this example, I think the stagehands might be the garbage men, but, you know, I’m good with that.)
The very best of Thanksgivings to you and your family — and as always, I am looking forward to your next missive.
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