Geoff Malcolm

I would like to introduce you to Geoff Malcolm, a man who has been very important in my life. Geoff was Professor of Physical Chemistry at Massey University. In 1974 he interviewed me for my first job there, showing me around the tractor sheds and wooden huts which then housed what passed for Physics accommodation. Geoff mentored me in my early years, and he was the person who broke the news to me when I was appointed Professor of Physics in 1984. Later, during a period when I experienced depression and doubt, he gave me the best advice one can give to an academic promoted beyond their level of self-belief. "There is no one way to be a Professor", he said. "Be the sort of Professor you want to be". That advice helped save me, and I have passed it on to many younger colleagues since. I think you will understand why I regard Geoff with esteem and affection.

An unusual day

Last night, as I slept, I had a strange dream, without structure, without event, without participants, just an odd sense of physical well-being, that I was in fact healthy, a feeling that persisted through the night, even across periods when I was awake. When morning came, my awareness of the tumours inside me was undiminished. Nothing had changed.

I have no explanation for the dream, except perhaps as some sub-conscious optimistic anticipation of forthcoming surgery. But this unusual night led to an unusual day, the first Monday of the new spring, following the shift of our clocks forward over the weekend. I decided to drive with Miang to Palmerston North to attend the funeral of an old acquaintance and friend, Florence Bacon. Florence's surviving husband Don had been Professor of Microbiology at Massey University, and I inherited his office in Tower C under one of our many relocations.

Florence (Flo) was an American, the daughter of Albanian migrants to the US. She met Don, a kiwi postgraduate student at Yale, while she was a laboratory technician there. She married him, and left behind her family to migrate to New Zealand. That was half a century ago. Flo became well-known and much loved in Palmerston North. She was a wonderful woman, savvy, funny, and warm hearted, the very best of America.

Miang and I drove back from Palmerston North in spring sunshine, wondering if our long winter was finally over. I felt both moved and privileged to have shared in the reminiscences of the Bacon family, as two daughters and a son spoke of their memories of their mother.

At the end of the funeral, we were invited to sing a song hardly ever heard in New Zealand, and one which I had never, until this moment sung. I finish here with its first verse.

O beautiful for spacious skies,
For amber waves of grain;
For purple mountain majesties
Above the fruited plain!
America! America!
God shed His grace on thee,
And crown thy good with brotherhood,
From sea to shining sea.

Batman gets his shirt

The person I am standing with is Chris Clark, an old friend and a senior scientist at Crown Research Institute, Plant and Food. Chris has recently been in Japan doing work related to our kiwifruit exports there, and took the trouble to seek out the perfect T-shirt for me.

Chris and his wife Delwyn, who are based in Hamilton, have been visiting Wellington this weekend to attend the WoW (World of Wearable arts) exhibition and show. Their visit here provided a wonderful opportunity to catch up and share some memories about Palmerston North days.

Completion

Today was a milestone. After 2 years and 6 months of work, off and on, the book is done, and I have finally sent the manuscript and electronic files to Oxford University Press. With 566 pages, 12 chapters, over 200,000 words, 264 diagrams and 890 equations, the book is a bit of a monster. I must have been crazy when I started this project. So "Translational Dynamics and Magnetic Resonance" is now in the hands of the publishers, who should have a simple job, given the electronic format I have used (LaTeX with .eps figures). In the last few weeks I have had enormous help from a young assistant, Dr Matthias Meyer, a expert in LaTeX formatting. Matthias and I are both pleased to see the end of the monster for a while.

Escape

I am now out of hospital. My immune system showed its strength in the blood tests and, armed with oral antibiotics, I have been allowed to go home.

Crossing the line

Each cycle of chemotherapy contains a danger period, just at the end of the 14 days of capecitabine oral drug. In the interests of reader sensibilities, I refer to this as my "Batman" period. The details are unpleasant and the curious can decode this nomenclature by checking earlier postings.

About 5 days after Batman's struggles begin, a new phase is entered in which my temperature starts to rise. If I can stay below 38 C I am safe. Above this, and I have to contact my oncology district nurse who then decides if I am to be bundled off to hospital. In cycles 1, 3 and 5 I managed to hover in the upper 37s. Cycles 2 and 4 saw me "cross the line".

Well, this is cycle 6, and last night my temperature soared to 39.2. So yes, I'm back in hospital again. If the medically wise judge that my neutrophil count is high enough, I may be allowed home tomorrow.


Miang making herself at home in the oncology ward and doing some work there while keeping me company.

Cytoreductive surgery, peritonectomy and HIPEC

For some time I have obliquely referred to "the Sydney option". Now I am in a position to give further information.

First some background. As I have previously written in this blog, my condition is known as "peritoneal metastasis". What that means is that cancer cells associated with my 2008 bowel tumour have escaped into my peritoneal cavity, seeding multiple tumours associated with the peritoneum, the membrane that forms the lining of the abdominal cavity and which covers most of the intra-abdominal organs and bowel. It is a relatively rare condition, in other words, you have to be unlucky with your bowel cancer to have this type of metastasis, and it is regarded as incurable, leading to death over a timescale on the order of 1 year. Unfortunately this peritoneal disease doesn't generally respond to systemic chemotherapy. My good luck has been to have an excellent response, but this response buys time, it is not a cure. Time is now running out. My CEA has plateaued and I can't take too much more of this chemical assault.

In April this year, my surgeon son Chris pointed out to me that a group in Washington DC, led by Professor Paul Sugarbaker, had pioneered a new type of surgery that seeks to cure peritoneal metastasis. The procedure is known as cytoreduction and peritonectomy with hyperthermic intraperitoneal chemotherapy. It involves completely resecting the peritoneum, removing all visible tumours, and where necessary resecting parts of the bowel. The gall bladder and spleen are permanently removed. As part of the surgical procedure the peritoneal cavity is filled with hot (43 C) highly concentrated chemotherapy agent, and for an extended period (~ 1 hour) worked into the tissue in an attempt to kill all remaining cancer cells. The physics behind this is straightforward. Once all visible tumours have been removed, what remains is small and has high surface to volume ratio, thus making it vulnerable to attack.

This is highly aggressive surgery, taking typically between 8 and 12 hours, with several days in intensive care in recovery, and at least three weeks following in a surgical ward. There is a high risk of complications, the most unpleasant being fistulae (bowel leakage).

This surgery is available only at selected places around the world, and not in New Zealand. However, as Chris pointed out to me, one of the very best facilities is at St George Hospital in Sydney, and led by surgeon, Professor David Morris.

In July I visited St George, met with Professor Morris and his team and, had my case assessed, based on multiple radiology. They gave me good odds for medium term (~ 2 to 5 years) survival and accepted me for surgery subject to funding, which they, being a public hospital team, preferred that I sought from the New Zealand health system. This surgery is not cheap!

In early August, my Wellington referring surgeon made a case to a New Zealand Ministry of Health fund known as the "Special High Cost Treatment Pool". Last night, I received advice that my funding had been approved. St George Hospital are now able to schedule me for surgery. probably at some time during the next 8 weeks.

I feel extraordinarily grateful to my country for supporting me in this. Miang and I were prepared to pay the full cost, but how gratifying to be supported as an extension of our public health system. This is is what St George wanted, to be able to provide this unique service to Australia and New Zealand.

My life is now about to enter a new phase. The surgical experience will be formidable, far more demanding than my 2008 bowel surgery, and will require all my strength. The risks are great, but this is my best chance of surviving beyond 2010. I look forward to this opportunity with fortitude and hope.

My sister Mary

This last week my younger sister Mary has come over from Melbourne to be with me while Miang is at a conference in Mexico. This is the second time in a month that she has given her time and care in this way. Mary, having been a senior nurse manager until recently, is now is part of a diabetes research team at the University of Melbourne, and she has had to organise her schedule to make these visits possible.

But what a great time it has been. To be with my sister, who normally I see only on busy family occasions, on a one-one-one basis living together at home is just marvellous. We can sit quietly, chat when we feel like it, share books, Skype Miang in Mexico each night, watch movies, share chores (though Mary is by far the better cook!), read the paper together, pop out for brunch (here is the two of us at Cafe Villa in Ngaio), do some shopping, go for a walk, entertain guests who drop in. And as a result I have learned so much about my sister's talents and personality that I never appreciated before. She of course has learned of my very bad habits around the house, but with her professional skills, managed to ensure that I drink the endless glasses of water, and remember to take my medications.

I should add that Mary has joined in my TaiChi class on two occasions and was completely at home with the group. And, she took me to Chemo IV this week at the hospital, which was a great opportunity for her to check out the New Zealand medical scene. The oncology nurses were delighted to meet her.

I am now half way through cycle 6. Next week is the start of my "Batman fights again" phase. My Avastin infusions have now finished. Whether I continue with more cycles of irinotecan/capecitabine (maximum 8 in total) depends on my CEA profile. As pointed out in a recent posting, I appear to have plateaued. This may be an indication that chemo is no longer effective. And then there is the "Sydney option" to be scheduled. More on that later.

PS: My heartfelt thanks to Mary's husband Tom who has gone without her company for yet another week!

Canterbury Earthquake

Canterbury earthquake and aftershocks
(Image MARK CORNELL/The Press)

At 4-35 am on Saturday September 4, a 7.1 magnitude earthquake struck the Canterbury region of the South island, with the epicentre at Darfield, 40 km west of Christchurch city, and at a depth of 10 km. Though there was extensive damage to buildings and infrastructure in and around Christchurch, there were no deaths.

Contrast this outcome with the 2010 Haiti Earthquake, magnitude 7.0, in which 230,000 people died, 300,000 were injured, 1,000,000 made homeless and 250,000 residences and 30,000 commercial buildings severely damaged.

Why the difference? Well, we were fortunate that the earthquake struck when most people were asleep in their beds. Had it struck at 4-53 pm, as in Haiti, then there would surely have been fatalities resulting from falling debris in the central city. But most importantly, the strict New Zealand building code which requires earthquake resilience, was the major factor differentiating these events. Most of the commercial buildings suffering major damage in Christchurch central city were pre-code (1935). A high proportion of Christchurch residences were damaged to varying degrees, but apart from a few pre-code brick mansions on rural properties, none collapsed.

The cost of repairing the earthquake damage is estimated at NZ$ 4 billion, about 3 % of GDP. Much of this with be covered by insurance, by the Earthquake and War damages fund (which has reserves on the order of $15 billion) and by central government grants to support local business and kick-start reconstruction. The country can handle the repair bill.

The impression here is that emergency services and civil defence system worked like clockwork. Power and water services were restored to most of Canterbury within a couple of days. Now that the aftershocks are subsiding, demolition and repairs are in full swing. It will take a year to complete the reconstruction task.

All-in-all, New Zealanders, and especially Cantabrians, can feel proud of the way we handled this potentially catastrophic event.

For a flyover of the fault line damage, check out

http://www.youtube.com/watch?v=Npqx3WmNkv4

Peter and Irene Martin

In 1981 my family and I had a wonderful sabbatical leave in Vancouver, where I worked at the University of British Columbia. Amongst the many friends we made that year were Peter and Irene Martin, whose sons David and Alan were of a similar age to my own two children. After not having seen Peter and Irene for at east 20 years, they turned up in Wellington the week and spent the night with me and my sister Mary (Mary is back from Melbourne again, looking after me while Miang is at a conference in Mexico).

This morning Mary and I gave Peter and Irene the Wellington "tour package" including a visit to the Zealandia Sanctuary (pictured), the cable car, Parliament, Oriental Bay and Mt Victoria, before guiding them to the Interislander Ferry so that they could continue their journey south.

Mum and Dad

In an earlier posting I introduced my siblings, Jim, Jeanine and Mary. It's time to tell you about my Mum and Dad, pictured here in 1946, the year before I was born. Mavis Hogg met Ernest Callaghan when they both worked at the DIC Department store in Wanganui. They married in 1934. Dad spent most of his earlier life in Napier where he witnessed the 1931 earthquake, being knocked off his motorcycle by the seismic shock. Mum had an itinerant earlier life as her family moved from town to town, South Island and North, for reasons of her miscreant father's making, as he found it necessary to hurriedly move his family out of town on a regular basis. None of my grandparents were alive when I was born.

Jim, Jeanine, Mary and I spent most of our childhoods in this 4 bedroom house in Wanganui East, the place of childhood legend, or, as Richard Green would have it, childhood pandemonium. Jim set a standard for adventure, which I was happy to follow and adapt. Dad, who was immensely kind, would sometimes curse me with words that still ring in my ear, to wit, "I hope you have a son who causes you as much trouble as you have caused me ", and, in confusion, would sometimes credit me with acts of heroic vandalism which were probably Jim's, but which I happily grew to believe were mine.

Mum was just endlessly patient, in the face of irate neighbours complaining about my latest outrage.

Dad was a draper, the co-owner of a dress fabric store ("Callaghan and Haworth") situated in the heart of Wanganui's Victoria Avenue. He had a lovely sense of humour and enjoyed chuckling and jesting. Occasionally, to my childhood disquiet, he would burst into song while driving the car. He had only a primary school education, but read a great deal of history, biography and travel, especially of the Antarctic heroic period. I can't recall how many times he told me that Scott would have made it back, if only he had included Lashly and Crean in the polar party. My favourite pastime was to argue with Dad about politics, business, life, or whatever. He humoured me by these jousts. He built me toys, including an extraordinary cart which, according to Richard Green, I drove hell mell down the Jones street hill with flaming petrol-soaked rags attached to the rear. When I nearly destroyed Dad's new car by wrapping it round a lamppost, he just repeated his despairing curse, and then life returned to normal.

Mum had a year of high schooling before escaping into retailing office work. She was what we used to call a "housewife", a great provider, like all Mums of that era. Hers was the close family that Dad (and the husbands of the remaining 8 Hogg girls) adopted, and the one which provided me with 38 cousins. Mum didn't worry when I disappeared until dinner time. She did cry once when seeing the welts on my backside after a one of my more severe secondary school canings, but sensibly heeded my pleas not to go to the headmaster. In other words, she trusted me to manage the adventures and traumas of growing up.

Though my primary and secondary schools beat me, my Mum and Dad never did, although once, following extreme provocation on my part, Mum begged Dad to thrash me, which he pretended to do in the bathroom in order that justice might at least appear to prevail.

Dad was never called Ernest by Mum's family. They called him "Cally", as did everyone else in Wanganui. He died at 83 in 1983, and Mum at 89, in 1999. This last photo shows them both in 1980.

I loved them and miss them both. Oddly, as I get older, I seem to carry more and more of them around with me. My external noisy gregarious side is Dad, along with any wisdom I might display. Mum is more of my complex inner self. I guess that's a form of immortality, having your genes and memes driving the lives of your offspring!


PS: Many thanks to brother Jim for these electronic images from the family archive.