David D. LevineScience Fiction Author

It’s been kind of two steps forward, one step back this month. Kate woke up one morning with chest pains and we went to the emergency room. They kept her in the hospital overnight for observation; it turned out not to be a heart attack, but was still a stressful and exhausting experience.

We also tried reducing the steroid dose again, and again this resulted in a return of the aphasia and other symptoms so we went back to the previous dose. She’s much better now, but after all that I feel that we’re basically back where we were at this time last month. We won’t be trying that again any time soon, unless there’s some solid evidence that she doesn’t need the higher dose any more.

We did get another MRI this month. We were both pretty nervous about the results, but when we saw the scan it was were pretty much the same as the last one, with some improvements. The areas of “enhancement” are a bit smaller, one of the spots went away completely, and there’s no indication of increased blood flow (associated with tumor growth). This is good news.

Also good news: we took a trip to Las Vegas, which went well. We saw three shows, ate many excellent meals, visited the Mob Museum, and goggled at the architecture. We did not gamble at all. It was a pretty laid-back trip by our usual standards, but we were exhausted when we came home; I’m really not sure whether or not we will be up for the square dance convention in late May. We’ll play it by ear based on our energy levels.

All in all, Kate is generally doing well. She can’t drive and can’t walk very far or very fast, but she’s been cooking and today she even took a trip on the bus while I was at yoga class. We hope for continued improvement in the months to come. If you can come by for a visit or send a card or some cookies, please do so.

As you may recall, I had a small spot removed from my nose two weeks ago. Well, I got a phone call from the dermatologist’s office yesterday, saying only “call us.” Unfortunately, I didn’t get the message until after the office was closed.

As you might guess, I didn’t sleep well. At all.

The news, when I finally got it this morning, was not what I’d hoped to hear but not nearly as bad as I’d feared. The spot is an “in-situ squamous cell carcinoma,” in other words a type of skin cancer. But it is not malignant, and is easily treatable: it’s a 15-minute procedure in the doctor’s office, with a 98% cure rate. Basically they just “scrape and burn” until they find healthy tissue. This a very common procedure; one in five people gets skin cancer at some point in their lives.

So, all in all, not too bad. But, seriously, this can stop any time.

Hug the people you love. And wear sunscreen.

Kate woke up at 5am yesterday with chest pain, and we went to the emergency room. Initial tests indicated it wasn’t a heart attack, but they kept her overnight for observation and more tests. Those tests also showed it wasn’t a heart attack, though it took until noon today to get a doctor to sign off on that and let us go home. :-(

It’s tough for the doctors to tell what the cause of the pain actually was, but it was likely heartburn from the steroids. Kate was already taking an anti-heartburn med (Pepcid) for that, but we got a prescription for a stronger one (Prilosec). We will also be seeing our regular doctor on Friday to follow up.

Hospitals make you “sick.” By which I mean that the simple fact of being in the hospital takes away your agency and turns you into a “sick person,” an object. Your clothes are stripped away and you are given a stupid gown that does almost nothing to protect your privacy or dignity. You sleep, eat, and drink on someone else’s schedule, and none of it well. You are forced into a horizontal position in which everyone literally looks down on you. You are poked with needles, given drugs which often make you feel worse, and forced into inactivity even if movement and exercise might make you feel better. It’s all done out of kindness and for the best of reasons, but the whole thing seems engineered to make you powerless and miserable.

The whole episode was time-consuming, anxiety-inducing, and exhausting, but at least it won’t cost us anything in cash — we’ve already hit our “out of pocket max” for the year. In the larger scheme of things, this was just a bump in the road.

Thanks very much for your support, especially Nancy, John, Dave, Merilee, Bo, Don, Janna, Mary, and Teresa, all of whom came by to keep us company and let me get away from the room when necessary.

Onward.

Things are going pretty well here. The last time I posted about this, we had tried reducing Kate’s steroid dose and the aphasia came roaring back, and we were just about to begin the second round of chemotherapy.

The chemo — five days of pills, with a doubled daily dosage — went off with almost no side effects, and the increased steroids have worked well. She’s gone from “can barely get a full sentence out” to “some hesitation and occasional wrong words.” The steroids do carry some undesirable side effects, including facial swelling and tremor, but for now we will just have to live with them. The next round of chemo begins later this week.

At the moment Kate’s biggest problems are strength, stamina, and balance. But those are all better than they were, and her mental energy and concentration are improved; she’s being all ambitious and proactive in a very encouraging way. She does have some memory issues, which may or may not improve with time. But she’s been cooking and decluttering and doing crossword puzzles and knitting (slowly) and just generally being more Kate-like. She can walk faster and farther than before, and doesn’t have to take several naps a day any more. Still not driving, though, and I don’t think she has the stamina to take the bus, so when I go out of town I still want someone in the house to help her. We both hope that won’t last forever.

We have continued trying to walk a lot, exercise several times a week, and eat right. Spring is definitely here (we’re well past crocuses and daffodils and into tulips and cherry blossoms), which makes the walking easier and more fun. And Kate has started working with her trainer at the gym again, which can be exhausting and sometimes kind of discouraging but a very good forward step. We could both be exercising more than we are, but what else is new?

I’ve been doing pretty well myself. Progress on the novel continues, I’ve seen some short story reprints, and I’ve been working on a novelette that I hope to be able to tell you more about soon. I’ve been doing weekly yoga and got a couple of days out of town on my own. I also got a small spot removed from my nose (“It’s probably nothing, but let’s take it off and have it analyzed”) and finally got a clean bill of health on my lungs, which we’ve been watching for possible sarcoidosis for the last year and a half.

Thanks to Janna, Andi, Dave, Will, Brenda, Ariel, and John (and possibly others I’ve forgotten), all of whom came by for a short or long visit. It’s greatly appreciated, because we haven’t been able to go to a convention or square dance for months. However, we are trying to get back to dancing (we’ll see how that goes) and will visit Las Vegas in late April. This trip is a bit of an experiment, which will help us figure out what we can and can’t expect to be able to do on future trips. In May I will fly to Southern California for a week to record some more technical training videos for lynda.com, and we hope to attend the annual square dance convention in St. Louis. After that, who knows?

Thanks for your visits and cards and letters and emails. This is a marathon, and your cheers help keep us going.

As you may recall, Kate finished up her daily radiation and chemotherapy treatments on February 3. The month of February was a month off from treatment, and we largely spent it relaxing. Though we were not able to attend Potlatch because of the risk of “con crud,” we did spend a weekend at the Sylvia Beach Hotel, a book-themed hotel at the Oregon coast (we had the Amy Tan room), and I ran off to the Rainforest Writers Village writing retreat, where I wrote an unprecedented-for-me 15,000 words on the sequel to “Arabella of Mars.” It was in general a very productive writing month for me… I also wrote a short story for a Chinese website and a novelette in the Wild Cards universe, about which I’ll have more news when they get closer to publication. We also saw five Portland International Film Festival movies.

During the month we had Tom and Karen, Sue and Alex and Cheyenne, and Mary Kay as house guests, for which we are very grateful, especially to Mary Kay who spent a whole week with Kate while I was at the Rainforest. Lots of other friends also came by to visit, and many of them brought food or helped with errands. I am also very pleased to say that we’ve begun cooking for ourselves again, at least some of the time, which is extremely satisfying.

For most of February Kate was getting gradually better, with the fatigue lessening and the aphasia very manageable, though she was still rather tired and wobbly. She was doing so well that we tried to wean her off of the steroids, which reduce brain swelling but have other, undesirable side effects. By the end of the month she was down to one steroid pill a day… but unfortunately the aphasia came back in spades, to everyone’s intense frustration. We just met with the doctor today and we are raising the dosage to two pills per day, effective immediately. Based on previous experience that should reduce the aphasia within a week.

Also at today’s doctor appointment we reviewed the MRI (brain scan) taken at the end of February. As we had been warned might be the case, there is quite a bit of “enhancement,” or tissue that absorbs a lot of the contrast material, at the edges of the place where the tumor was removed. There’s no definitive way to tell from the MRI what this is, but the blood flow in the area and the timing (three months after a successful surgery) imply it’s radiation damage, which often heals by itself, rather than new tumor growth. Again, this is something we’d been warned about beforehand, so we are not yet overly concerned about it. We will continue to use steroids to treat the accompanying swelling, and hope for the best.

But we are not just hoping. On the advice of the oncologist, naturopath, and other professionals we are trying to eat right (lots of vegetables, lots of fiber, mushrooms and active-culture yogurt every day, and few refined white carbs) and get as much exercise as possible. The steroids have caused Kate to lose a lot of muscle, so we are starting with just 15 minutes of gentle exercise 3 times a week, aiming to bump that up by 10% every two weeks. Exercise has all kinds of benefits, including reducing those steroid side effects and the chance of cancer recurrence. I’m trying to get more exercise myself, including yoga once a week and plenty of walking. The weather is improving, which will make this easier.

The second round of chemotherapy begins as soon as we can get the drugs from the special pharmacy, likely this week. This is the same drug as before, Temodar, but at about twice the dose. There’s a greater risk of nausea with the higher dose, but as Kate had no nausea to speak of in the first round we hope that it won’t be a problem this time either. Despite the higher dose, many patients find this second chemo round to be much easier than the chemo + radiation in round 1.

Kate will take chemo pills for five days, then have 23 days off, then repeat for the next six months or so. We can expect fatigue, but few other side effects, so we hope to be able to do some travel, even international. We’ll know more next week about how well she tolerates this therapy.

All in all, apart from the current aphasia (which we hope will clear up soon), things are going about as well as can be expected. Your help is greatly appreciated and will continue to be needed going forward; if you can come by with a home-cooked dinner or to do laundry or dishes it would be wonderful.

Thank you all very much for your help and good wishes. They mean more to us than I can say.

My story “Mammals” has appeared on StarShipSofa, narrated by me!

On Monday, February 2 — Groundhog Day! — we went to the hospital for Kate’s last radiation treatment. (She had already taken the last dose of chemo on Saturday night.) Got the treatment, met the doctor, got a dorky little certificate and discharge paperwork… and then the doctor came back and said that there had been some kind of mix-up in the paperwork and there was actually one more treatment to go.

Groundhog Day!

We just laughed, and came back the next day, and got another dorky little certificate. And then we went to meet with the naturopath.

I had been leery of naturopathy, thinking (basically just from the name) that it’s a woo-woo pseudoscience akin to homeopathy. But after several different people recommended it, I did a little research and discovered that it’s actually a science (or can be, depending on the practitioner) which attempts to improve health with proper nutrition and exercise. And there are even naturopaths at our cancer clinic! So we met with one of them, who looked at the diary Kate had kept of everything she had eaten in the last three days and asked a lot of questions, after which he said that we’re doing pretty well.

He recommended more walking — a LOT of walking, as much she’s capable — as a good general all-around health improver and particularly valuable for cancer patients. Breast cancer survivors, he said, have as much as 50% less recurrence if they walk daily than if they don’t. He also recommended eating mushrooms every day (they are full of protein and fiber and a variety of possibly-cancer-fighting antioxidants) and prescribed some supplements — powders to be mixed with yogurt — to improve the health of the gastrointestinal system, which is hit pretty hard by chemotherapy. All of this seems pretty reasonable, so we are going to try it. I’ve even set up a star chart to track our daily walks.

So now we are all done with radiation (for good) and chemo (for a month). To celebrate this victory we got donuts from Blue Star — ssh, don’t tell the naturopath — and I cooked us a dinner of kung pao chicken, which is the first dish I ever cooked for Kate, back when we were first going out.

During this month off we can expect the fatigue to get worse for a while, then slowly improve. We will be ramping the steroids down as much as possible. Then, beginning in early March, we’ll be doing chemo on a four-week cycle (5 days of daily pills, 23 days off) for six months or so. The chemo dose will be higher, but as there’s no radiation and she continues to heal from the surgery we have hope that life will be somewhat closer to normal. We are even starting to make travel plans for those six months, with the oncologist’s blessing.

All in all, Kate came through this six intensive weeks of therapy in remarkably good shape. She is tired, naps frequently, and has some side effects from the steroids, but her language skills are almost back to normal. She does still have some other cognitive deficits, but they are subtle — if you didn’t know about the cancer and the brain surgery, you might not notice anything wrong in an ordinary conversation — and we hope they will continue to improve. Her mood is good, and mine is also greatly improved. Which is not to say we don’t have bad days, but we are much happier than we have been in weeks, and I for one have begun being able to worry about things other than cancer, like deadlines. Also, Kate’s starting to feel kind of stir-crazy, and if you know her you will understand that her NOT being stir-crazy during the last two months of not going anywhere shows just how poorly off she was. So in a couple of weeks we’ll be heading to the Sylvia Beach Hotel on the Oregon coast (we have the Amy Tan room) for a relaxed getaway. We also got tickets for some Portland International Film Festival movies.

So, things are going well. We aren’t out of the woods yet, but we are out of the dark tunnel and the sun is shining on the tracks ahead. If you would like to drop in for a chat, run errands, or bring by a pie or a casserole, they would still be welcome; just drop me an email or a text before you come. I will send out an email if we need anything specific.

I’m certain that we would not be doing nearly as well now if we hadn’t had so much help and support from our friends and relatives. Thank you all so very much for all of your help and good wishes — it means more to us than we will ever be able to express.

I’m working on a short story which I’ve decided to set at the south pole of Saturn’s moon Enceladus. I thought I would share with you a few paragraphs from my notes.

How big is Saturn in Enceladus’s sky? According to Wikipedia, Enceladus orbits 237948 km from Saturn and Saturn is 108728 km in diameter (pole to pole). Popping these two figures into the angular diameter calculator at http://rechneronline.de/sehwinkel/angular-diameter.php tells us that it is 25.7 degrees wide — bigger than your spread hand at arm’s length (about 20 degrees). On Earth, the full moon is 0.5 degrees wide — smaller than your finger tip — so Saturn is 50 times wider than that. The rings would barely appear as a line, because Enceladus orbits within the outermost E Ring and the rings are less than a kilometer thick (but the rings’ shadow is visible on the planet’s face, changing with Saturn’s 29.5-year orbital period).

Enceladus’s orbital period is 32.9 hours and it is tidally locked, keeping one face turned toward its primary at all times. Unlike Earth’s moon, it does not librate (wobble). Its axial tilt is zero and the inclination of its orbit relative to Saturn is very near zero. This means that as seen from the south pole of Enceladus Saturn sits on the horizon, with its south pole uppermost and the line of the rings horizontal (but this line is so fine as to be nearly invisible, and it’s probably below the horizon anyway — however, when seen from anywhere other than the pole, the E ring in which Enceladus is embedded may appear as something like a Milky Way). Because Enceladus is tidally locked, Saturn does not move in the sky at all, but it does go through phases along with Enceladus’s day, with a complete cycle every 32.9 hours. You can always tell what time it is on Enceladus by looking up at Saturn (if you happen to be at a place on the moon where Saturn is visible).

The shadow of Saturn falls across the rings during the Saturnian equinoxes (every 15 years). When this is happening, Enceladus experiences a solar eclipse every day. For how much of Saturn’s year does this occur? Saturn’s axial tilt is 26.73 degrees, which means that the sun rises 27 degrees above the horizon at the solstice. Since Saturn is 26 degrees wide in Enceladus’s sky, 13 degrees of that is above the horizon (as see from the pole), and the sun rises at most 27 degrees above the horizon, that implies that these eclipses occur during (very roughly) half of Saturn’s year: those periods, near the equinox, when the sun is less than 13 degrees above the horizon as seen from the pole. That’s about seven years out of every fifteen.

Around the solstices, when the sun is higher in the sky than 13 degrees, there are no eclipses. The eclipses begin with a brief blip each day (the sun appears to graze the top of Saturn in the sky) and get longer and longer as the equinox approaches, maxing out at about two and a half hours (26 degrees / 360 = 0.07, times Enceladus’s 32.9-hour day = 2.37 hours) — these maximum eclipses occur at the equinox, when the sun as seen from Enceladus appears to be in Saturn’s ring plane. Saturn’s equinox is also Enceladus’s equinox (axial tilt zero), so the period of maximum eclipses is also the time when, as seen from the pole, the sun drops below the horizon and is not seen again for 15 years (or reappears after a 15-year absence). The period of eclipses lasts for (very roughly) 4 years of increasingly long eclipses before the sun vanishes and 4 years of decreasing eclipse length after it reappears, with seven years of no eclipses in between.

All that being said, sunlight at Saturn is only 1% of what we see on Earth, so whether the sun is in the sky or not, human eyes would perceive the scene as near-perfect blackness. My astronaut main character will need an image-enhancing faceplate.

ETA: Dr. Plotka writes to say: “1% of the Earth’s sunlight is plenty for seeing things. The sun is very very bright, and we don’t need anything like that much light. Specifically, full sunlight on Earth is up to 100 kilolux, so on Enceladus it would be around 1 kilolux. Which is about the same as TV studio lighting, and twice as bright as a well-lit office.”

ETA 2: Rob French says: “I don’t think you meant to say that the shadow of Saturn falls across the rings at the equinox. Maybe the shadow of Enceladus? The shadow of Saturn falls across the rings the entire year.”

My reply: I wasn’t clear on what I was trying to do there. The real question I was trying to answer was: how common are eclipses on Enceladus? Or, to turn the problem around, for how much of Saturn’s year does the planet’s shadow on the rings reach all the way to Enceladus? It does at the equinox, obviously, when the shadow and the rings are coplanar, but for how much of the year on either side of the equinox does that remain true? The answer is that Saturn’s shadow reaches Enceladus for about half of Saturn’s year.

Just heard from David Afsharirad, editor of the forthcoming Baen Books anthology The Year’s Best Military Science Fiction and Space Opera. “I’d very much like to include your story ‘The End of the Silk Road’ in the book. I can’t say how much I enjoyed the story. As a fan of early 20th century detective and science fiction, it was a real treat.”

“The End of the Silk Road” is “Venus noir,” in the mold of C. L. Moore’s “Northwest Smith” stories, with froggy Venusians, a damaged protagonist, love, guns, and betrayal. It’s set in the same universe as my forthcoming novel Arabella of Mars, but where that book takes place on Mars in 1813, this story is set on Venus in 1936. It isn’t “military” in the least, so I assume the title of the anthology is to be read as “Year’s Best (Military SF) and (Space Opera)” rather than “Year’s Best Military (SF and Space Opera).”

The Year’s Best Military Science Fiction and Space Opera, the first in what Baen hopes will be an annual series, will be published as an ebook on May 16, 2015 and in paperback on June 2, 2015. It already has a cover and preorder pages at Amazon and Powell’s.

Baen will also be using the book as a ballot for a new readers’ choice award, to be presented at DragonCon. Voting will be done via online poll. More details as I have them!

The passage of time has become very strange for me. The days seem to drag by, but the weeks just zip past. I really can’t believe that two weeks have passed since my last update, and that only one more week of radiation and chemotherapy remains.

We have already finished up the main course of radiation, which irradiates a softball-sized area around the (removed) tumor, and entered the final “boost” phase which focuses on the area of the tumor. The last treatment is on February 2 — Groundhog Day! — and after that there will be no more radiation. Daily chemo ends on January 31, then after a month off will resume with a one-week-on, three-weeks-off cycle for about 6 months. That second round of chemo is supposed to be more tolerable than this initial, aggressive round of chemo and radiation, and we hope to be able to travel and otherwise resume something resembling normal life. If nothing else, the absence of daily radiation appointments will be a great relief.

Medically speaking, for Kate the last two weeks have been similar to the previous three. Her speech and motor issues are very much improved, to the extent that she now seems to have few problems speaking most of the time (though she says it’s harder than it looks). We have begun scaling the steroid dose back down, with a target of getting it down to zero for the coming month off of treatment. Side effects are somewhat worse, though — she is quite fatigued now, taking several naps per day and not able to walk more than a few blocks at a time. We are trying to get up and out every day, though, and the fatigue is not nearly as bad as what we’ve seen in friends taking intravenous chemo.

For myself, it’s been increasingly difficult. With our friends’ help I’m keeping up with everything that has to be done, but I’m tired and achy and often very sad. I’m also having some gut issues, about which the less said the better. I am working with a counselor and doing everything I can to relax, including yoga, guided visualization, and as much walking as I can manage. I have asked for, and am receiving, help from friends to get out of the house when I can. I believe that my stress levels will improve once we are done with this round of treatment, with its daily hospital visits and many pills which must be carefully managed.

We have had house guests nearly every day in the last two weeks. Janna cooked us a brisket, Mary Robinette made three pies, Allan helped us buy a recliner, Sue made sure I got to the gym, Brenda washed the kitchen floor, and all of them did much else besides. Each of them brings a special set of skills and energy and all are very much appreciated. This is in addition to the many local and non-local friends who provided transportation; helped me get out of the house to write, do yoga, or see a movie; sent or brought food; or just came by to hang out. We are so grateful to you all.

We had hoped to be able to attend Potlatch, but at this point this seems unwise due to the fact that some of the drugs make Kate more vulnerable to infections. Alas. On the brighter side, my story “Damage” was published at tor.com and is getting a lot of buzz and rave reviews. You can read it here: http://www.tor.com/damage-david-levine

Thank you very much for your love and support. With your help, we will get through this.