Momentarily Phree

BMT squad goals: Seth and Phin outside the RMH

Hey there Phin phans! Dustin here with an update. Here we go!

Recap

Phin was diagnosed with acute myeloid leukemia (AML) in March of 2022. He spent five months in the hospital, did four rounds of chemotherapy and count recovery, and rang the bell in August of that year.

For the next 18 months, everything looked great. Phin went back to school, traveled, went to birthday parties, played with his sisters and friends, and learned how to swim, ride a bike, and ice skate. He went to clinic checkups, his scans all came back clean, and the appointments got fewer and farther between.

In February 2024, Phin relapsed, and since then he’s completed two month-long chemo-and-recovery rounds at the children’s hospital in Savannah and then transferred to the state’s only bone marrow transplant site at Children’s Healthcare of Atlanta. He received a bone marrow transplant from a non-related donor at the end of May and spent the following weeks inpatient on the BMT unit at CHOA receiving more chemotherapy and waiting to see if the bone marrow cells he received would engraft.

On June 24, he was discharged and rang the bell for a second time.

Phin is currently staying at a Ronald McDonald House in Atlanta, where he will remain for the next several months so that he can be monitored and more easily attend his frequent clinic appointments. 

Milestones
Here’s a video of Phin ringing the bell after he completed his treatment plan on the BMT unit at CHOA:

Medical Updates
It’s 8:50 p.m. on Monday, July 1, and we’re back at the hospital. I’m writing this from a room in the ER, where Phin was told to report because at his clinic visit this morning he complained about a tooth, and the nurse practitioner poked in his mouth and made some notes, and after she consulted with his main BMT doctor it was decided that the best thing to do would be to have him come in.

They think it’s probably a puss-filled abscess under his gums, and since his new bone marrow is still setting itself up in his system and his counts are low, they don’t want to take a chance that the infection in his mouth spreads. They’re going to take some X-rays, and probably they’ll keep him here until they pull that troublesome baby tooth out. But they’re full up on the BMT unit where we were just a week ago, so we're waiting. We hope they’ll find a room for us there soon. 

Phin On the Daily

The week between when Phin left the hospital after he rang the bell and when he returned this evening is similar to the year and a half he spent in remission after he rang the bell the first time back at the hospital at home. Both times, he was pretty fragile as far as his immune system goes, which means we had to put limits where he could go, what he could do, and whom he could be around.

But that never stopped him from enjoying every day and enjoying his freedom. This last week, he went hiking and

explored the trails behind where we stay. He went to a drive-in movie. He had late-night movie parties and built blanket forts with his sister, who’s visiting this week. He drove all around on his ride-on Land Rover, which was brought to him from home by our dear friends and neighbors Bev and Seth, who stayed in the same room we’re currently in at the Ronald McDonald House here in Atlanta when Seth was doing his own bone marrow transplant several years ago. Phin did yoga and lifted weights. He played Battleship and assembled Lego sets. He even went to one of those drive-through safari places where zebras and ostriches come up right up to the vehicle, and he wasn’t even bummed when we warned him about germs for the millionth time and told him we had to keep the windows up.

All in all, he had a really full week. Phin lives hard. That’s basically how he did it the whole time he was in remission. It’s like he’s making up for the time he lost. Or, maybe he’s living as much as he can right now, in the present, because when it comes to the future, you just never know.

Hopefully...

We knew when we left the BMT unit last week that we'd probably be back sooner or later. That's kind of why I wasn't too upset that I forgot to grab our snacks out of the communal fridge when we took off. Still, we hope this tooth abscess thing is a quick and easy fix and that Phin can go back to the Ronald McDonald House, where he has a lot more freedom and room to move.

Aside from that, we're also thinking about one of our dear friends right now who is waiting on some test results to come back. We're really hoping those results are good.

Thanks for reading, pham. More soon. Stay safe until then.

Twelve Days Post BMT

Hi Phin phans! It's Dustin with a quick update. Let's get it!

Milestones

It isn’t really a milestone for Phin, but it’s Neesha’s and my fifteenth anniversary this week. It's been interesting for us to reflect on the life we've shared. From this vista, looking back at the path that brought us here and the way it has twisted and turned, we see the point at which our boy appeared, at almost exactly the midway mark. Roughly half of the path we've walked together as a married couple has been one with Phin at our side, and roughly half of that stretch of trail has wound through places that all parents dread. I suspect more of the same terrain lies before us as well.

But what about before? What were those early years like, before Phin and before Phin's cancer? That seems so long ago. As anyone who has cared for a sick loved one before will attest, not all years are the same in terms of length or weight. Sometimes it turns out that a single year can contain many lifetimes. Neesha says she remembers having thought until Phin fell ill that we had achieved the kind of success and happiness that she had hoped for when we said our vows, and from this vantage point I can see that she was right.

My journals for those years tell a much different story--one of absolutely manic trepidation. The accounts seem so pitifully small now. This awful thing had happened at work. This landlord had suggested something about our lease. This petty coworker had ranted in a meeting. This whisper of coming change had made its way to my ears. On and on, page after page. Always a looming darkness. Always an existential threat. Always the scratching of wolves at the door.

This was my constant fear, expressed in some form on each page of my daily journals, year after year--that we would face a threat too fearsome to overcome, that we had brought children into this world who would depend on us, and that we would fail them. 

It is not just in hindsight that the challenges our family has faced seem small, but in comparison to the towering threat of leukemia. But in any case, Neesha's perspective from our time before Phin's diagnosis seems the more focused and accurate, the confident, well-adjusted mindset of a wife who appreciated that things were good before they got bad. It is even possible that being with her for this many years has even begun to change my perspective as well. The same anxieties about failing our children still plague me, but I am at least a little more capable now of sifting big, deadly threats from small, annoying ones.

Medical Updates

This is Day +12--twelve days post bone marrow transplant. We continue waiting to see whether the bone marrow Phin received has successfully engrafted. It’s in him, but will it do what it’s supposed to? Too soon to tell. 

Phin got transfusions of blood yesterday and platelets the day before. His counts (white blood cells, red blood cells, platelets) continue to crater, but that's expected. He received his final dose of chemotherapy this week. We hope it's the last one he'll ever have to get. 

Mucositis has been Phin's main issue since the previous update, tanking his thirst and appetite. He's on both IV nutrition and feeds through his NG tube since it's uncomfortable for him to eat or drink much. If he's experiencing actual pain, however, he's kind of shrugging it off. He's got a button that lets him take morphine hits, but so far he's only touched it once to test it out. He was concerned that pressing it would summon his still mostly unfamiliar CHOA BMT nurses to his room and that they'd start messing with him, and we had him press it to show him that no, instead it just sends pain meds through his line. Even after that demonstration, he hasn't touched the button since. 

Other than that, he's been getting some pretty powerful antibiotics to fight off any bacteria that might try to make a move on his system now that his counts are so far down. His doctors are particularly watchful for the drug-resistant E.coli that knocked him flat before we left Savannah. His diarrhea-causing C.diff (not to be confused with CDFF, which is a dating app, apparently. Did they seriously not even Google that name before they launched? Like, how does that happen? I'm being for real here because I just Googled the disease and the dating app pooped popped up. And is it like, "Hey you guys are a really cute couple but how'd you meet?" "Oh, you know, we both had CDFF and one thing led to another." "Uhhhh. Ew.") appears to have resolved, which is awesome because 1) no more diarrhea and 2) no more being confined to his room in quarantine. 

Phin On the Daily

Phin couldn't go outside his room for the past couple of weeks, and he's spent most of that time in bed feeling kind of wilted. His iPad screentime is way up, and most of it comes from him endlessly mainlining these stupid Youtube videos of the same two adult idiots narrating themselves playing Minecraft.

Here is a sample transcript:

"Bro! Where are you?"

"Bro! I'm over here!"

"Bro! I can't find you!"

"Bro! Go this way!"

"Bro! There's a creeper!" "Bro! What the heck, bro!" "Bro!" "Bro!" "Broooooo!"

It has been ... difficult ... for me. One of many tests.

But Phin has had a little more energy these past couple of days, and with that renewed vigor a little of his light has returned. He's back on the BMT unit floor walking his laps again. AND thanks to a yoga mat Neesha got him that has illustrations of poses printed on it, Phin has gotten really into yoga and makes time to practice. He's also been doing his physical therapy and playing games like Trouble, Uno, and Memory. All of this is good, in my opinion. He's slowly clawing his way back out of the abyss of Bro! Bro. Brooooooo.....

As for how the girls, Neesha, and I are doing, I guess we're okay. The girls are back home with Neesha's folks. My brother will give them a well-earned week off starting Saturday. They've each started summer theater camp and they're excited about it. They look forward to that every summer. Neesha and I are pulling our tag in/tag out relay act here in Atlanta, with one of us always at the hospital and the other at the Ronald McDonald House. We have everything we need, but we're tired. Neither of us sleeps very well these days. The hospital is comfortable enough, although there is a pervasive sense of ... impending doom? That isn't quite it. It's more like the vibe people in a scifi movie have when they're trying to escape a planet that's breaking apart. There are signs everywhere about the new hospital complex that's opening this fall, and often these signs appear very close to others that read "out of order." The prevailing ethos seems to be, if it breaks at this point, it isn't worth fixing. Not super reassuring for parents of children with serious illnesses.

The RMH is very peaceful, however, nestled as it is against the edge of Emory's Lullwater Preserve. I often cut through the woods on my way to and from my shifts with Phin at the hospital, even though I'm fairly sure it's trespassing. There's a little waterfall back there, a giant lake, all kinds of trails, and a bouncy suspension bridge over a creek. The forest is deep and full of shadows. Neesha thinks it's creepy and probably full of bodies. I fell off a log I was walking across like a balance beam yesterday as I was dissociating and doing Christopher Robin stuff back there on my way home. I'm okay though. Just got my clothes a little muddy is all.

Dear Donor

May 31, 2024

Dear Donor,

At this moment, your carefully packaged and stored cells are making their way across the ocean and have been en route since approximately 5 a.m. They will arrive in Atlanta around 4 p.m. our time, be transported by the same courier who has accompanied them since they left you in Italy, and be delivered here to Phin in the hospital where I type this letter; in this same room where he sleeps soundly with only the humming of his IV machine, the same machine that hums away in the background of my morning will disseminate your cells into his body around 9 p.m.

When I gave birth to this little boy, exactly seven years ago tomorrow, I thought I had seen all the miracle there was to giving life. I have been humbled now to learn the extent to which miracles of birth and life are happening every day through divinity, through science, through you and your gracious sacrifice to offer up the very core of what churns your own healthy blood to try and save the life of my only son, a stranger. Across all disciplines, one thing we can agree on is that "the life of the creature is in the blood." Your selfless donation will take over the role of giving Phin viable life--producing new, healthy blood to replace the tarnished, fatal kind his body has learned to make. 

It has not escaped me that you were willing to donate without knowing anything about my child, the life you are donating to, and I have wondered what brought you to this place of selflessness, what made you get on the registry at all? Was it someone you loved who needed a donor that inspired you to swab your cheek? Was it a case of happening upon a Bone Marrow drive, shrugging your shoulders, and thinking "why not"? At twenty-six years-old--the age you are now--Dustin--Phin's dad--and I were graduate students whose days were filled with the works of Montaigne, St. Augustine, Sei Shonagon. We spent all of our time consumed by writing and reading and teaching. I was working toward becoming someone who I thought would have something more to offer the world, not realizing at all what you already know: that deep within the spongy parts of my bones, we all already have something to offer the world, a potential cure for at least one life. At twenty-six, by donating your marrow, you have already done something so many of us will never do--saved a life.

Dustin at 26 years old

Neesha at 26 years old

I want to share with you about the life you're saving. Yes, Phin is a six-year old (seven tomorrow!) boy from Georgia in the United States, this is true, but Phin is also a humble lover of animals. Just yesterday, we spent hours watching live cams of any animal he could think of. "Pandas!" He'd shout enthusiastically, and we'd Google search a live cam. Time would pass and his eyes stayed fixed to the squooshy black and white bears, wandering around their enclosure, eating leaves and climbing. Phin--a silent observer of their meanderings. To know Phin is an animal-lover is key because he will not produce animal facts for you like some children who are enthusiastic about their interests do, rattling off everything they know about their beloved. He is humble; his knowledge must be coaxed. If you ask Phin about animals, he will just say he likes them. But if you engage him with conversation, say "The Atlanta Zoo is home to one of the smallest bear species..." he cannot contain himself from exclaiming "the sun bear!?!" Which is correct. Which I also didn't know until this very exchange happened yesterday between Phin and someone who had once worked at the zoo.

Phin observing animals at the zoo

Phin is insightful and keenly observant. I have shared before now some of the fantastic, wise things Phin says--among them that "Life may not be fair, but it's good" and that "behind the storm, there is light"--but his daily observations are keen and witty. When I once asked about whether he'd like me to procure contact information so he could talk to more of his classmates at school, he said "I don't know if you know this, Mom, but a lot of six-year-olds are not good at conversation." When he came home from playing with a group of neighbor kids, he declared one had a crush on another; days later, his 13-year-old sister, with amazement in her eyes, confirmed his observation, declaring "Phinny was right! I don't know how he knew, but he was right!" 

He is confident, cooperative and able to compromise and self-regulate. Like many little boys, he likes sports and video games, but he's willing to take turns choosing the game, to allow others to take the lead, but to take charge himself, if necessary. He recognizes kindness in others and holds those friends in the highest of esteem. He is kind--if you fall, Phin will always stop to help pull you back up, even if you are three feet taller, even if you yourself are a stranger to him.

He is a little brother to two big sisters who dote on him, the definite spoiled baby of our family and our only boy; the fifth member of our clan, who loves things like smoked salmon, avocado, steak, green eggs and ham, chicken tikka masala, and Thin Mint Girl Scout cookies. He is the only one of the group of us with a dimple. It's hidden in the right lower side of his cheek, so close to the fold of his smile, you might miss it if you're not looking closely enough. He laughs with his whole heart, sometimes collapsing down by the strength of his joy. He is oh so loving. At this very moment, he is saving all his Tooth Fairy money up so I can quit my job and spend every moment he's home just playing and hanging out with and loving him with nothing else to worry about.

We have given Phin to the world, and you have made it possible for the world to continue having him. I think of you every day as if you were one of my own children, pray for you every night, thank the universe for your selflessness, willingness, for your heart and goodness, for your "yes". I promise you now to mold this little boy into a man who is selfless, full of love and goodness, a person who will be willing to say "yes" when it matters, who recognizes his worth and ability to make a difference in the world by taking time to love and care for others any way he can...a person, who I imagine, will be just like you.

Phirephlies

It wasn't long ago that Dustin asked if I thought it was time to relinquish the use of "ph" in place of "f" in our blog posts or titles. I said maybe it wasn't necessary anymore, but here I am, keeping it alive, unintentionally.

We've arrived in Atlanta. We're settled into the Ronald McDonald House and we've been pivoting as the need arises. Just days before we left, my dad (Pepop) came down with a cold. We couldn't take him with us because the risk to Phin and us was too great. A cold is not much to think about when it comes to any of us, but for Pepop, who is still regularly treated for his own cancer, it can take longer for it to resolve. For Phin, it could be catastrophic. For us in our life right now, it would mean Phin would have no caretaker to stay with him. We had to bid Pepop farewell and walk the path alone until he's better.

Phin and I went ahead, arriving in time for me to teach an evening class and for us to check out the Ronald McDonald House and the many sources of relief it has to offer. There is almost no way to describe what they've created here--this haven surrounded by woods--something I never stopped to think much about as I rounded up my change to be donated as we drove through a McDonald's for a Coke (my guilty pleasure because, let's face it, no one's Coke holds a candle to the one from the fountains at McDonald's) or to pacify the pleas from our kids. When I used cash, I'd stick some into the slots in the restaurant itself, again, never thinking much about it. "If you have enough to give, you give" has always been my motto. Now that we are the recipients of the immense care this facility offers, I cannot urge you enough to round up, shove some money in those slots; what we are experiencing is nothing short of the greatest peace of mind after a long day or many at the hospital. The only ache I feel is that Phin cannot get such reprieve from the hospital. There is always food--breakfast items, leftover dinners, hot meals at night. There are warm beds and laundry facilities; there are playrooms for the kids. There is solace. What I didn't expect was that there are also fireflies.

On Friday, we got news that our beloved Aunt Bev--Dustin's Mom's sister--had died quite suddenly and unexpectedly. It was impossible to stop the tears. Aunt Bev welcomed people into her life with her whole heart and devotion. She was kind and generous and it is impossible to think of a world existing without her. We carry this sorrow, unable to push the 'pause' button on life and all its whim throws at us, into our journey, shouldering it as we go.

Phin is starting to feel the effects of the Busulfan he's taken. This is a chemo with strength we haven't experienced with his prior chemos before. It is designed to kill his stems cells, clear out the old to make room for the new. It, like all the others, has side effects, and one of those is nausea. When I left Phin Saturday, he became nauseous and has remained that way ever since. He's a tiny guy, not much more than 44-46 pounds on a good day. When we started this relapse journey he was only 47-48. It's hard to see him this way--alternating between resting and vomiting, knowing how little he already weighs and worrying about how much more he can lose and maintain the strength he needs to fight through what's coming. It's hard to know that this might be the easiest part of the even harder side effects that are yet to come. 

Back at the Ronald McDonald House, I worried. I'm still worrying, really. I carried that worry and all the others that lie ahead as I went down to the car to bring up a care basket our dear friend Stephanie had dropped off for us. Worried about his strength, his body, his side effects, the ones yet to come, mourning Aunt Bev, knowing only one of us can go to her memorial, and neither of us can be with our girls to comfort them. As I carried the basket back to the elevator, looking into the woodsy abyss before me, I asked the universe, God, any force that has influence, to help my sweet boy, to heal him forever here with us, to hear us, and suddenly, there was a blink of light in the darkness. I stopped in my tracks, blinked a few times myself, took a few more steps and there it was again, and again, and again. Fireflies. 

Fireflies are going extinct. As a child, we'd see them all over, catch them in jars and watch their magic, then release them back into the night. As an adult, I've often wanted to share this magic with my children, but never seemed to find many around, causing me to research and discover they're dying off. Fireflies are symbols of hope--a light in the dark abyss when it seems there is none. I needed those blinks of hope at just that moment and I stood out there a long time just watching them blink golden in the dark, as if I were collecting them again in a jar in my heart to light the darkness when it comes, to remind me that even in the abyss of despair, there is hope, no matter how exhausting it may be.

Today is day -2. We count down to day zero, which is transplant day, then begin to count up again. Phin's birthday is day 1, the first day of his new bone marrow--a more fitting date could not have been chosen.

Today is also the internment of our dear Aunt Bev in Missouri. Dustin has joined his family there and will return tomorrow. He will quarantine for several days to make sure he's not unwell and doesn't unintentionally bring some ailment back to Phin. Please pray and send good vibes for all of us, including Phin's donor who will give her donation tomorrow. Every one you send out is like a firefly of light in the dark unknown that lies ahead.

-N

The Plans

The Treatment Plan

Neesha and Phin walk between units at CHOA

Somewhere across the Atlantic Ocean, far away in Italy, a 26-year-old woman with 0+ blood type is preparing to be put under anesthesia to undergo a thirty-minute or so procedure where surgeons will extract liquid marrow from the back of her pelvic bone. 

There's a good chance she may have to fly or take a train to a different city to give this donation. She might have to take off from work, and to leave all that's familiar to her--family and friends--to offer up this gift to a little six-year-old boy who lives across the ocean in the United States, a little boy who bravely battled leukemia when he was four-years-old, only to have it return again almost two years later. A little boy whose best chance at survival is her--a 26-year-old stranger across the ocean. 

Having studied abroad in Italy as a young twenty-something myself, I (Neesha) can almost smell the cornetto cioccolatto (flaky chocolate croissants) fresh out of the oven, wafting through the air as she passes over cobblestone streets in her ballet slipper shoes on her way to a train station somewhere on the edge of town. I can almost see her reflection in the windowpane transposing her face against the Italian countryside as the train rolls along to its destination. Feelings of anxiety, determination, conviction swirling inside as she moves further from home, closer to her donation site.

European donor laws dictate that we cannot know this woman, this willing savior, nor her identity in any way but through anonymous letters sent through the NMDP over the course of the next two years. Once those two years are up, if she chooses, we can discover her identity and attempt to thank her properly for her selflessness, no matter the outcome. Although really, what thanks could ever be enough? 

Until then, we are confined to anonymity, our letters subject to NMDP readers who will censor any identifying information that cannot yet be shared. This means we have approximately two years to learn Italian. I have already started Phin on "Ciao." I am brushing up on my Italian (it's been 23 years since I studied abroad in Italy). I propose we all learn so we can visit her together when Phin is 9 years old to show her how grateful we are!

By the way (interjects Dustin), we fully understand the need for anonymity in this process. We applaud that feature. Consider what might happen without that measure of anonymity. It isn't hard to imagine the terrible possibilities if the bone marrow donors and the recipients (and their families) all knew who each other were beforehand. Keeping secret the identities of the parties involved helps safeguard this beautiful, selfless, miraculous act against corruption, extortion, and violence. 

Phin prepares for more scans at CHOA

As so many of you know through following Phin's journey, we were in Atlanta for a good portion of this past week where Phin underwent a variety of tests: lung, heart, kidney function, psych evals, social worker evals, financial evals (for us)...etc. He had three pokes (needles), three IVs, and about 6 blood draws. He spent at least 5+ hours in various hospital rooms for two days in a row. As per usual, he was a rockstar. There were moments of fear; there will be lost of adjusting, but a few things were familiar: the warmth, care, and love for patients that we have grown accustomed to, and Aries, dog of war, who will be a furry friend to Phin during his stay. 

So here's the plan, as I know many of you have asked and been waiting for updates. Thank you for your patience and grace, Phin phans. It means so much to us that you care and that you're following along. It's easy to feel lonely in this childhood cancer world, but because of you all, we have never felt truly alone. 

Tuesday, May 21: Dustin, Neesha, Pepop (Neesha's Dad), and Phin move to Atlanta to settle in for Phin's transplant

Wednesday, May 22: Phin has his first official clinic visit (all his testing was in the hospital specifically, so we have yet to see the pediatric oncology clinic, which is also in the hospital)

Thursday, May 23: Phin admitted to hospital; central venous catheter line (aka Hickman or CVL line) placed, chemo begins*

Thursday, May 30: DONOR DAY! Our hero in Italy will donate her marrow today; the courier will await the completion of her procedure, then immediately take the donation, jump on a plane and fly back to Atlanta where they will bring the donation to Phin at the hospital

Friday, May 31 (aka Day 0 aka Phin's "rebirthday"): Phin will be given the new marrow from his donor. This is received by him just like a blood product transfusion via his CVL. The procedure is definitely more invasive for his donor than it is for Phin

Phin and Pepop have lunch 
after a busy morning at CHOA

Saturday, June 1: Phin and Pepop will celebrate their birthday. Phin will turn 7; Pepop will turn 82**

At this point, our biggest prayer is that the marrow will then make its way into Phin's bones and start setting up shop and churning out some new bone marrow. If this works, it's called "engraftment" and usually takes place about 2-4 weeks following his receiving of the new marrow. If it works, Phin's blood type will also change to reflect the blood type of his donor. He will go from AB+ to O+. 

There will likely be graft versus host disease (GVHD). They will be monitoring Phin's vitals, weight, blood work, and organ functions very closely for infection and diseases that can flare up or occur as a result of his marrow being wiped completely out. Some expectation of GVHD could result in the killing off of any leukemia cells inside of Phin that may have survived or hidden themselves well enough as to not be detected. 

(This reminds me: the results of Phin's most recent biopsy tell us that he is STILL in remission as we head into transplant (we were in Atlanta when we got this news, so it may have been overshadowed by all the new info we were getting, but was still HIGHLY celebrated when we learned of it.) 

For the weeks following, there will be many potential dangers and the three of us will be diligently taking turns at his bedside (two at a time) keeping him positive, active, and engaged as much as he is able...and watching for any dangers that may be on the horizon.

We will be in Atlanta, at the bare minimum, for at least 100 days following transplant.

The Home Plan

So what about our girls, right? 

The girls are finishing up school this coming week, then Obelia will begin theater camp and continue through most of June while Avonlie joins the fray of theater camp in two weeks. That means three shows in June. Once they finish theater camp, Av has one more theater camp in mid-July and both girls will attend soccer camp (maybe a volleyball one for Av, too) during July, as well. 

They will likely also be in Florida for a week or so visiting cousins and celebrating my sister's birthday. Granny will be the main touchpoint holding down the fort during this time, although it is our biggest hope that once we are confident the worst has past and Phin is stable, Dustin and I can begin rotating back and forth in Savannah and Atlanta every week or every other week so each of our children will see at least one parent on a daily basis. The twenty-minute commute from our house to the Children's Hospital of Savannah (CHOS) was way more convenient for swapping back and forth every day than the Savannah to CHOA commute (approximately 4-5 hours, depending on traffic).

A Word of Recognition

While we were in Atlanta, one comment I made again and again to various evaluators was that we are extremely fortunate. 

I know that sounds weird given what we're living and what lies ahead, still--and we have a lot of emotions about that we can share in another post--but we have the privilege of having very hands-on, supportive family. My brother Kiran was here taking care of our girls and keeping things on track for at least a month or more since Phin's relapse. My mom has been in our house doing the same and will continue on as long as we need her. My brother Amit, sister-in-law Seale, niece Genevieve, and nephew Jacob, have visited, picked-up, attended events and housed our girls multiple times across these last few months. My sister Sara, brother-in-law Coire, and mother-in-law Vicki all have plans for devoting their time to the care and keeping of our kids over the course of the next few months. 

We have an employer who rearranged scheduling to allow us to continue teaching (which, btw, we do both really love so I hesitate to even call it a job because it feels like so much more than that) and who provides us with excellent healthcare insurance. We have administrative healthcare professionals and organizations who have guided us through this journey, helping us secure secondary critical care insurance for Phin, making the phone calls and sending the necessary documents to the necessary places. We have friends who are willing to jump in at a moment's notice--to mow our lawn, to take care of our pets, to offer a set of watchful eyes, to pull in packages, give advice and lists on tips for navigating Phin's transplant. 

There is no doubt that having a child with cancer is a crummy hand to be dealt, but of all the terrible things about this phase of life, we are incredibly fortunate. Dustin says he's come to think of it like there are different kinds of good fortune. While were were extremely unfortunate in that our son got cancer, we are keenly aware of how fortunate we are. We have good health insurance, plentiful resources and numerous people who can help us, excellent healthcare options for Phin (locally and within a driving distance). We are going into this terrifyingly hopeful part of Phin's cure in a better position than so many other families. Being asked so many questions by our folks at CHOA that revealed the many deficits at work against cancer families really humbled us because even in the face of the worst, we are still blessed a million times over and we are so SO grateful. 

By Request

These are not needs. We talk a lot about "needs vs. wants" with our children so I want to be clear when I say that the following information is offered not out of need, but out of request from so many of you who want to do or give something. We have an Amazon wish list for Phin. It is tentatively titled his "Birthday and Rebirthday" list since from now on, he will forever have a two-day celebration of birth and rebirth. I can vouch for the fact that Phin is content and doesn't really want much of anything. The items on this list are items he's said he likes/wants, that we think he'd like or want; they may be items we see him enjoy regularly (Thin Mint cookies, hot chocolate, cooling pillows/pillowcases) or that he has a similar version of at home but will not have access to in the hospital. A few are things we will have use of while in Atlanta.

Phin’s’ Birthday and Rebirthday List

The Bonfire link is to Phin Phan merch! Our dear friends Betty and Paula and Heather really did a lot of footwork to get our first round of items created and dispatched. We are so grateful for all the time and effort we know that must have taken (although they humbly deny it). Phin does love to see people wearing his logo (courtesy of Marcus Dove at Kustom Hustle) and a portion of the proceeds from these items does still come back to us. In case anyone forgot to order or missed the ordering deadline, these items are "on demand" so you can get them as you think of them or if you decide you want something. 

Phin Phan Merch

Please do not feel obligated to do any of the above. Once we arrive in Atlanta and have a mailing address or room number for Phin, we will share that info, as well.

For now, we are spending the rest of the time we have together packing for the trip and loving one another. Monday we will have a small family celebration for Phin's birthday; Tuesday we leave for Atlanta. Wish us luck and keep those prayers, good vibes, manifestations...all of it...coming our way.

Thank you, Phin pham. You have no idea how cherished you are.

*Chemo in the days leading up to Phin's transplant will be harder than previous rounds he's endured, largely, because this chemo is meant to truly wipe his marrow down to nothing. We've seen his numbers low before, but this will not only wipe him out, but serve as an ablation to opening up his bones for the new marrow.

**If you are new to this journey, Pepop and Phin are birthday twins. Phin was born 75 years to the day of his grandfather's birthday. My dad--Pepop--was present for his birth and very nearly had to deliver his grandson because he was coming so fast. Both of these warriors have been battling cancer simultaneously. Pepop was diagnosed with multiple myeloma one year before Phin was diagnosed with acute myeloid leukemia. Pepop's plan is to stay with Phin throughout treatment. He is a retired physician and we are grateful to have his expertise and devotion in Atlanta.

Bridging Chemo: Complete

Hey there, Phin phans. Dustin here with a quick update as Phin prepares to head to the Children's Hospital of Atlanta (CHOA) for the preliminary and preparatory procedures before his scheduled bone marrow transplant (BMT) at the end of the month. 

As you all know, Phin completed the bridging chemo segment of the treatment last week after a harrowing scrape with e.coli that threatened to push back or derail the BMT. But it could have been even worse than that. As we've mentioned before (although not in a while), once people with leukemia start chemotherapy, it usually isn't the cancer that gets them. It's regular old infections--germs that normally wouldn't stand a chance against a functioning immune system. Phin's scrape with e.coli the week before last was the closest we've come to losing him since this whole thing started back in March of 2022, but his physicians made excellent decisions, the antibiotics worked, and Phin recovered. A few days later, he packed up his room, got one last spinal tap and bone marrow biopsy, said goodbye to his nurse squad, and headed home. 

Since it's also been a while since we did a photo essay, here's a quick recap of Phin's time at home so far, on the eve of his first on-ground CHOA appointment. 

Neesha and Phin look back as they exit the Children's Hospital of Savannah. Between his first rounds in 2022 and the treatment after his relapse in 2024, Phin has spent roughly eight months of his life inpatient at this facility. Phin crosses this physical and symbolic threshold with a measure of ambivalence--glad to be going home but apprehensive about leaving behind familiar faces. 

Requests from Phin are few and far between, but one thing he's said he wanted since early in his initial leukemia experience when he was four was to plant a tree--and not just any tree, but a sycamore, which can grow to be so massive that we weren't sure how to realize this dream in our own little yard. The neighborhood HOA made it happen for him, though. Phin's sycamore stands at the edge of the neighborhood playground overlooking the lake. He loved making its acquaintance.

Phin and his big sister Av play on tablets together in Av's room. Phin had missed his sisters tremendously during this latest round. Unlike his hospital stay in February and early March, when his sisters could come visit and even have sleepovers, Phin spent much of the bridging chemo phase in lockdown. Even with those precautions, infection found him anyway...which is why, when Av suddenly came down with a fever mere hours after this photo was taken, the house instant went to DEFCON 2 and Phin was evacuated to his grandparents' house. He'd barely even been home for a day. 

Phin's grandfather takes his temperature as Phin watches TV at his grandparents' house. The orders we received from the oncology team at the hospital upon discharge were clear: Bring him back the minute his temperature exceeds 100.4 degrees Fahrenheit. After we arrived and all that night and the next morning, Phin's temp would repeatedly approach 100 degrees, but it always came back down. His sister recovered the following day. 

Phin and his grandmother play the card game war. Tablet-less for the first time in weeks, Phin rediscovers the excitement of playing games face-to-face with his grandparents.  

The town where Phin's grandparents' live has lots of ponds inhabited by alligators, and a tradition of ours hearkening back to when we had to flee germs when he was immuno-compromised last time is the self-guided gator safari. It's basically just us driving around looking for gators or swooping through parks that have ponds and seeing what kind of reptiles we can find lying around without getting too close. We found three this day. 

His grandparents' town also has a playground that looks like a pirate ship. The last time we were there, he was in remission, and he played there with his sisters and cousins. As he played, we remembered that time, and we talked about how he'll get there again, only this time we'll do it in a way that makes it so his cancer can never come back.

"But it'll take so long," he said.

He's right, but he'll get there. He's on his way. He's made it across the bridge. 

When it cooled down in the evening, Phin, Uncle Kiran, and I went mini golfing. No particularly amazing shots, no holes in one, but Phin lasted all 18 holes. That in itself was a win. 

Last but not least, Phin did finally get to come back home, the sickness there having cleared, and even better because it was Mother's Day. Here he is celebrating with his cousin, G, and his mom. Cousin G embroidered his logo for him. Very awesome. 

That's all for now. On to Atlanta for a few days of appointments, consultations, and examinations at CHOA. Wish us luck, and we'll catch up when we return home at the end of the week. 

Phragility

The summer Phin turned four, Av came home not feeling well after camp. We figured it was a virus; pediatrician and urgent care suspected the same. She tested negative for everything: strep, flu, mono, covid, but her symptoms worsened. I remember her pale, her quiet moans. 

Av, Phin, and Obie, summer 2021

"It's hard to even breathe, Mama," she'd croaked out, clutching her throat, tears tipping out from her eyes, fast-moving, leaving dark wet tracks on her white face. 

Her fever stayed high following antibiotics and Tylenol, nothing touched the pain or temperature. It took days and two ER visits ending with an admission to the hospital before figuring out what was wrong. Despite having been rapid-tested twice for mono with negative results, she ended up being hospitalized for mono--not your usual kind where you might be super tired for a long time and weak, but the kind that does all the rare things that only happen occasionally: enlarged spleen, anemia, swollen lymph nodes so big they pressed against her airway, making it difficult to breathe. She needed strong steroids, could barely walk (for weeks) for more than a few minutes, couldn't sleep for months for fear of her airway closing, remembering the terror and pain she felt when it nearly did.

Another time, just after we moved to our house, Dustin ran a tiny, three-year-old Obelia into the kitchen bawling, her hand covering her mouth. As he set her on the kitchen counter yelling for me to come look at her, she moved her hand to reveal a face full of blood; it poured out of her from a gash just below her lip where she'd nearly bitten through her mouth after tripping on the porch stair and falling. Even now, I feel woozy to think of it. In the ER that same day, she begged me not to make her do it. "It" meaning endure a numbing needle to her face, followed by stitches sewn close together to close the fabric of her skin. 

If you're responsible for a child on a regular basis, you know the desperation and pleading in their voices, the ache of having to force something onto them for their own good despite having spent years teaching them to advocate for their own bodies and to never accept anything by force. It is painful to live out this juxtaposition, to feel like a hypocrite as you become the enforcer of the unwanted because you know it is needed. Maybe we comfort ourselves knowing that it's "for the best" and that "one day they'll understand", but when a child is battling cancer and you face this limbo several times a day with no certainty of healing in sight, this pain is a sustained one, the uncertainty of "one day" making your role harder to accept. What if we don't make it to that day of understanding? Will they carry this indignation at your betrayal? Will it be what they recall at the end?

And, at the time, I was traumatized by every one of those instances. I still feel a sort of helpless anguish remembering Av's fear of falling asleep and Obelia's desperate pleas. There are other experiences, surely, that I'm forgetting now in the wake of the life we are living, but each time a medical emergency happened, my heart pumped, my mind struggled to keep from panicking, I worried and waited for the worst possible news. When it didn't arrive, we went blissfully on our way, tucking our biggest fears aside for bigger medical emergencies, secretly believing that they would never come.

Until they did.

Phin's AML diagnosis came a mere nine months after Av's stint with mono, the effects of which would linger long after she left the hospital. At the time of Av's mono diagnosis, I (and friends whose children had faced down cancer) had feared they would tell us she had cancer. We even asked and the attending doctor assured us her blood count numbers would look far more frightening than what they were seeing then. Relieved, we celebrated having a clear diagnosis, others celebrated with us. We knew in our hearts that what we were really celebrating was the curability, the commonness of what she had and the reassurance she'd conquer it and be back on the streets in no time riding her bike, skateboarding with friends. We celebrated that it wasn't cancer.

How innocent we were of the foreshadowing that came with that experience--how, less than a year later, we'd come to learn exactly what a cancer patient's blood counts looked like, exactly what it felt like to live in that sustained state of terror.

You may have noticed we have our finger on the pulse of Phin by the numbers. We know exactly how many nights he's slept in a hospital away from his bed, our home, his siblings; we know exactly how many blood draws, clinic visits, infusions he's had. It's not because we're numbers people--if you've been around long enough, you know we are not numbers people (ELA all the way!); it's because of Phin's beads. One of the things Phin enjoys and is most proud of are his Beads of Courage. When Dustin and I swap out, I usually ask Phin if they've updated his booklet. He tells me no (even if they did) and we talk through it together. 

Phin and his beads

"I had a bandage change. That's a bead. And the thing here," he says to me pointing at the NG tube woven through his nostril and taped to the side of his face. "Is that a bead?" "That's a bead."

Phin gets a bead of courage to mark the challenges he overcomes during his cancer journey. He gets a different colored bead for things like bandage changes, overnight stays in the hospital, pokes/blood draws, IV infusions, chemotherapy, medicated mouthwash and eyedrops, all sorts of tests (echocardiograms, CT, Xray...etc.) and on and on. His booklet fills up by the day and once we complete one, we move onto another. This is how I'm able to quantify these experiences, to tell you that in the last few days Phin has had one bandage change, two fevers, constant IV infusions, at least 14 blood draws, light sedation, five CT/Xray exams, and two NG tube placements and an eventual removal. In total, I think it's safe to say he has collected more than 1,000 beads over the course of his treatment, and having now grown more familiar with what they're all for, I can assure you there are many I forgot or didn't realize he should be receiving. Some days--like the last few--there are many beads; other days there are just a few. Each time we look at his beads, I am thrown into something of a montage-daze, recalling each event that took place on that day and the series of days that might follow, remembering the ache of each memory. All the moments of begging and reluctant acceptance we go through in one week with Phin amount to more than I experienced as a parent with three children combined across six years before Phin's original diagnosis.

When I think of trauma now, I envision  holding Phin's hands for comfort while he willingly lies on his back and endures the removal of a sticky bandage that tugs painfully at the sensitive skin on his chest, over his heart, and beneath his armpit no matter how careful the nurse is that removes it. His tears stream; he screams about it hurting, about him hating it, about how he wants them to move slower or faster. He leaves his body open and still for his nurses despite this pain, never protesting against what they do with anything more than his words, knowing it's an essential act that must be accomplished no matter how much he hates it. We all--a parent, nurses, Phin--go through this at least once every seven days.

I think of Phin's eyes welling up with tears as I lie him in the cradle of a CT scan machine, promising him I will be right there, I will hold his hand the whole time, begging him not to cry hard, to stay calm so we don't have to repeat the scan again. The tears stream as they shift him into the mouth of the machine, his tiny hand squeezing mine as he goes, his muffled sobs as he tries to stay calm. 

Phin prepping for another CT

I hear doctors explain that they want to run tests to make sure there's "no bacteria around his heart" or that he doesn't have symptoms of "typhlitis"--a life threatening inflammation for a patient like Phin. Every treatment asks for us to compromise, to bargain, to potentially sacrifice some part of what should be a normal part of life for Phin for just a chance for him to live. Imagine being asked, not hypothetically, but with very real likelihood, on a daily basis questions like: "Would you trade your hearing for a chance to live? What about your ability to pay attention? How about a few inches of height? Your ability to have children of your own in the future? Would you be willing to potentially come to the oncology clinic regularly for the rest of your life to treat long term effects of all the blood product transfusions you had? Hip replacement sound OK, even if it happens late in your teens and you'll need both? What about your major organs--are you OK with damaging your major organs in exchange for being allowed to keep living?"

These questions remind me of the futile bargaining I have done and am regularly tempted to do with God or any unseen force who might hold reign over divine interventions. Because, as I know you have experienced at least once in your life, there is nothing I wouldn't give, nothing I wouldn't trade to have Phin back home, healthy and driving his sisters crazy, running out the front door to play with friends, swimming in our neighborhood pool all summer long, slipping quietly into our bed in the middle of the night. The difference is that my bargaining is wishful; the repercussions we bargain with for Phin during treatment are very, very real.

Phin on the mend

For Phin, there has almost always been trauma; his life is a series of unending traumas that he has accepted, that we cannot take away, cannot stop and that I can hardly bear, stopping myself a million times a day from breaking down in the face of his bravery. And every day we face a new onslaught of trauma on his behalf, secondary to the constant trauma he has come to know as the definition of life.

Yet he laughs on, plays on, endures each unimaginable request, each monstrous fear placed before him, slaying them all each day in quick succession in ways most of us will never have to understand.

And, my God, does he do it all with so much grace.