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.