Read through the Leukemia and Lymphoma Society’s booklet “Understanding Drug Therapy and Managing Side Effects. I was struck by how unemotional and cold the section “Social and Emotional Effects of Drug Therapy” was. Why should it matter, and what is this emotion thing anyway?

The answers are found, I think, in the left brain/right brain thing.

What is it emotion? For me, good emotions are the pleasure that I get from Mo and Miranda and the wider family. Looking at art and listening to music. Friends. Touch. I think of my walks with Diggory in the town forest, enjoying the current season, whatever it may be. The forest has a special but restrained beauty to me, because I also have in my head what it looked like last month, whether it be seeing the first lady-slipper of the year, or because the first fall of pine needles laid a golden carpet that will last only for a few days before dulling.

In my blog entry earlier [day 13] on atheism and prayer, I referenced Paul Bloom’s article in the Atlantic Monthly. His thesis is that belief in God comes from an overshoot of the perception of a mind/body split. We are pre-wired to be dualists. Once you accept that the spirit (or soul) is different from the physical body then it’s but a short step to God, the creation, and the afterlife.

Scientists broadly reject these three notions, or at least, reject them as science. Theists allow for the existence of all three beliefs (God, Creation, and the Afterlife). There are eight different possible combinations of beliefs and it would be interesting to find out the number of folks that fall into each bucket. Let’s call the following the GCA model. (It’s probably not original but I have not come across it in this way before – and not that I’ve been looking particularly hard.

	GOD	CREATION	AFTERLIFE
YES	a	b	c
NO	d	e	f

Intelligent Design folks, for example, would hold that condition d, b, any is possible, i.e., Creation by an agent other than God. I have met people who believe that condition d, e, c is possible, i.e., there is no God or Creation, but there is some form of Afterlife. And I think that Orthodox Judaism may hold that conditions a and b are true, but not c.

But this model is all red-herring. I think the questions surrounding warmth and caring have to do with the different roles of the left-brain and right brain. It would be interesting to integrate the L/R brain model with the GCA model, but this may prove difficult since the L/R brain model is not a yes/no thing.

I wrote earlier [day 11] about how the mind is involved in the healing process, and in particular, in the reduction of medical error. This is obviously a left-brain thing. When most folks are talking about mind they are talking about a right-brain thing. Monica wrote me afterward about the role of music therapy. She’s right. In my eagerness to play up the rational aspects of mind in the healing process, I downplayed the role of faith and omitted any reference to the role of creativity. It seems a little odd to label creativity as a science, even though recent advances in understanding it have come from scientific research. Betty Edwards talks about research into the corpus callosum and its role in communicating between the left and right hemispheres, and this is a book published in 1970. I would suspect that there have been other advances made since.

Science is often thought of as being analytic, with little or no role for creativity. The biographies of influential scientists show that this is far from true. One of my favorites is Dick Feynman, familiar to physics student for his three classic books, “The Feynman Lectures on Physics.” Non physicists know him better as the member of the Rogers Commission investigating the space shuttle Challenger accident, who, during the hearings on Capitol Hill immersed an O-ring in a cup of iced-water and showed how it became less flexible. He had widespread and curious creative passions, such as his love for Tuvan throat singing. Top doctors are often accomplished in playing classical music. But most of us are not top scientists, and the population at large views science as having no heart.

I don’t know much about music therapy, but I find in my present condition that listening to music helps me in various ways. First, it helps to center me when my mind starts to wander for whatever reason. Secondly, and classical music in its broadest sense, is particularly useful here. Following the story of the music exercises the mind.

[Correction to previous entry It was not my great-grandmother, but my paternal grandmother, Lily Stanton, my father’s mother. She was a member of the Apostolic Church, not the Assemblies of God. My uncle Alan remembers when he was about 8 being warned against going to the cinema: “What would you do if Jesus came while you were there?”]

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Tried to sleep but couldn’t, despite having two ambiens in me. The air is very dry in here and they keep it so to minimize the risk of infection. No new symptoms, and in fact my temperature has been down to 98°. But I have all the old ones. I need to moisten my lips with petroleum jelly (manufactured in New Paltz, NY, where Mo and I had our first date – the Northern Light?) otherwise they’d stick together. I have to cough every five minutes or so. Trying to do less dilaudid – since I stated the other day I’ve become very itchy indeed, one of the side effects of the drug – a synthetic morphine. (Not sure if I wrote this already, but I am on a PCA where, within certain limits, I can self-administer the amount of pain medication I receive. My settings are a steady rate of 0.6 mg/hr, with extra shots of 0.5 mg allowed every 7 minutes. Sort of like ordering an espresso!). I am comfortable with my mouth open or closed – opening and closing it hurts my lips – but keeping it open means I dry out more quickly. Keeping it closed increases the amount of pain that I notice coming from the sores in the roof of my mouth and gums. I am, truth be told, a bit afraid to sleep since I wake up so disoriented.

On the positive side, my skin itch is much lessened as well as my bedsores. All the doctors and nurses and PCAs and other specialist staff continue to take excellent care of me here. Well, they forgot my ice cream on the dinner tray this afternoon, AGAIN! Paula took care of me and rustled some up later in the evening. Food tastes better and I’ve figured out what I like and don’t like.

I finished another exercise from “Drawing on the Right Side of the Brain.” This time of the square-rigged ship at the beginning of the Aubrey-Maturin books. This is the exercise where you copy a picture upside-down in an effort to trick the right brain stay out of it and focus on shapes, lines, and their relationship to other shapes and lines. The problem in this case is that the picture is intended as a left-brain illustration, since it names all the 21 sails – not that I know the names of all of them. I also could not stop myself from counting the gun-ports – thirteen on each side (well, on the larboard side, at least.) Towards the end, Rose came in to take my vitals and broke my concentration. When I got back into it I wanted to rush, and surprisingly this seemed to work better. I need a better picture, but not much around here.

Spent some time this afternoon fixing the links on my website and adding a few photos that I’d taken with my cell-phone. Maureen sent me a shot of the fireplace at home with stockings hung and the angels on the mantle. I have that as the wallpaper on my cell phone. Mo also sent a picture of the tree, strung with lights. Working on this stuff keeps my mind active and I don’t mind the pain so much and that means I don’t scratch so much.

When will all this go away? It’s hard to say. Dr. Sloan stopped by before leaving for the weekend and went through my hematology report. The report lists the results of tests that the lab performs on blood samples that the nurse draws daily through my portacath, every morning at 4 am. The report lists:

1) Test name. Some are obvious, for example WBC means White Blood Cell count, while others I will have to look up.

2) The actual quantitative result of the test

3) Whether the test is in the normal or abnormal range, or has changed significantly (over the last 24 hrs?)

4) The units of the measurement. WBC, for example, is measured in K/ul, which I read to mean 1000s per microliter.

For my 12/9/05 report, of the 22 tests conducted, 12 were flagged as abnormal. The key metric to look for, apparently, is WBC * POLY. When this exceed 0.5 my body will take over and clear up all my aches and pains within 24 hours. Currently, WBC = 0.23 K/ul, and POLY = 72%, so the magic metric is 0.166. Still a ways to go. I’ll start entering this in an Excel spreadsheet so I can track my progress. Measuring stuff is pretty much the same in medicine as it is in FAA Flight Standards.

Had a good night’s sleep. Got over my fear of sleeping by playing an Afrocelts CD (Volume 1, Sound Magic) followed by Seed. http://www.afrocelts.org/ Slid into blissful union with the music where it felt as if my friends were listening with me too. Slept until 4 am and woke not disoriented at all.

There’s a nice class of combinatorial problems that nurses solve every day, to do with the order in which drugs on the pole are fed in to me. As an example, my antifungal medication is in a D5W (dextrose) solution and has to be by itself; the others, in saline, can be in different orders.

My portacath has two lines that go directly into a reservoir that was inserted in my chest, located on the right side above the nipple and level with the armpit. The nurse has discretion, within the rules of drug interaction and delivering only those medications prescribed for me, for when to feed the medication and what other drugs to feed it with. Other constraints include the overall volume of liquid pumped into me, and, in the case of blood, my temperature – blood cannot be fed in you are running a fever since it independently causes your body temperature to rise a few degrees. There is a potential source of error here because of the wide range of solutions to the problem of how to administer the medication. It’s also potentially a time waster since the nurse may have to solve the problem many times over during the shift. In addition, it’s subject to interruption as the doctor may add, modify, or delete a medication order.

Another method of delivering medication is oral. For example, flagyl can be oral or IV. It is preferably given oral to reduce the space required on the pole. However, flagyl tastes extremely nasty and the first time I took it I threw up. For a few times after that I took it in gelcaps, which is where the nurse cuts up a pill and puts it in a gelatin capsule. The merest grain of flagyl on the outside of the capsule, left there by accident as a result of cutting up the pill in house, can still cause me to throw up. And this is what I did. Now I take flagyl by IV, which further reduces the amount of space on the pole.

Yet another method is injection. I get my G-CSF this way via a shot in the belly.

I have not counted the number of different medications and additives (potassium, magnesium, etc.) that I’m taking, but it’s a lot. For the chemo drugs alone, I’m taking 13 different drugs, which in some cases must be given both IV (intravenous) and IT (intrathecal, or direct into the spinal column). So, there are many ways to screw up, as well as very severe consequences in some cases if you overdose or omit the dose. [See James Reason, Beyond the organizational accident: the need for “error wisdom” on the frontline. Quality Safety Health Care 2004:13:28-33]

There is a reverse danger. If all decisions are automated, nurses may perceive that someone is trying to turn them into automatons. While I think there are, and will continue to be better and more sophisticated automated solutions for heath care delivery, we need to make sure that nurses don’t lose opportunities for patient interaction when they can check other less measurable aspects, such as the patient’s mood. [It is commonly held that 80% of all human communication is non-verbal]. Also, nurses take justifiable pride in their ability to solve problems of drug interaction and delivery, and pride in one’s work is a key attribute of a well functioning team