Reading My Friend Peter’s SNAFU Letter at Christmas Time: A Reblog Prompted by a Stranger’s Final Twitter Message

I’d never heard of the man whose tweet was the first to appear when I signed on to Twitter yesterday. (Yes; I’m still there.)

It was his final tweet, he wrote. He wasn’t just leaving Twitter: he’d been struggling with cancer and had about two more days to live. He wanted to thank everyone for their friendship and send his love and good wishes to all.

I’m not sure how many of us will get to decide how we’ll be as we near death. It’s not something we like to ponder. But I was struck by the grace of this man’s final tweet. It reminded me of my friend Peter, whose intellect, humor, imagination, and generosity of spirit were present in abundance even as he endured stem cell transplants–and the accompanying indignities and sometime absurdities of hospital treatment–in the hopes of remaining on this earth a bit longer.

Here is my tribute to Peter, which appeared in December, 2019:

I’m not terribly fond of Christmas letters, which sometimes resemble those Facebook entries in which people tell you all the details of their day, including every morsel they ingested.

But there was one letter I always looked forward to receiving. It was from my friend Peter, my colleague at the continuing medical education company that was my last job before retirement.

Technically, I was Peter’s “boss,” a word I loathed, as I really believed in a collaborative work environment. But with Peter, it was irrelevant: he needed no bossing. 

Though his position was medical editor, he possessed two masters degrees and a PhD. It was our/my great good fortune that he wound up in that office. He was brilliant.

In terms of his work, that meant not simply meticulousness about spelling, grammar, punctuation, organization—even style. He would find errors in physicians’ manuscripts and illogical conclusions in published journal articles.

And he would rewrite passages of the manuscripts we were preparing that wouldn’t otherwise pass muster. Oh, how he could write!

He also had a very offbeat, sardonic, often hilarious wit with an eye for life’s absurdities that others might miss.

And his restless intellect encompassed such varied interests—many different types of music, especially opera (the more obscure, the better), good films, politics, travel, and on and on—that his Christmas letters were a joy to read.

The absurdities parts were often featured prominently. I loved them.

At some point a number of years ago, Peter developed a dry cough. His doctors treated his symptoms, but they lingered.

After several weeks, he told me he was having night sweats. That set up a warning light for me, and I asked him if I could check with a physician friend. She led him to the oncologist who diagnosed a rare T-cell lymphoma. The prognosis wasn’t great.

But Peter had a strong will to live, and he beat those odds. We celebrated his five-year survival.

In his Christmas letters, he wrote about all the medical indignities and horrors he’d been subjected to with an astonishing degree of humor and objectivity—and not an ounce of self-pity.

A few years later, the company we worked for was failing, and I was required to lay off Peter and several other terrific people. I wept; Peter was visibly upset, and I worried that he’d never forgive me.

But he did, and my husband and I attended several of his delightful home musicales/dessert parties, where he and some friends, accompanied on the piano by his very charming and talented music teacher wife, regaled us with songs. He had a fine tenor voice.

Then came a SNAFU Christmas letter, explaining in a matter-of-fact tone that the lymphoma had returned, and treatment had once again commenced.

This was 11 years after his first occurrence. We had all been so sure it was a horror that he’d never again have to face.

After that, Peter’s SNAFU letters weren’t just at Christmas. He began regularly describing his strange new journey—always with humor, always with a sense of the absurd, and—once again—always without self-pity.

He went through hell, but he never dwelled on all that.

His last missive was dated October 20. It was longer than usual because the process to prepare him for stem cell transplantation had begun.

He knew the odds were not in his favor, and he knew what he was facing, but his incredibly strong desire for life overrode all else. 

He titled the email “SNAFU Sequel: A Million.” The million referred to the first count of his harvested cells. But “a million cells is not like a million dollars,” he wrote.

“Ideally, a transplant for T-cell lymphoma requires 6 to 10 million stem cells.”

The last amount he documented was a harvest of 2.8 million cells, and it was increasing.

Despite his situation, he found silliness everywhere. Told in the hospital to go to room 318 for an MRI, he walked through a long dark corridor where there were no rooms.  Suddenly the hall ended and became room 318,

“and there we entered a new dimension…The room and atmosphere reminded me of the creepy opening hotel lobby scene from Stanley Kubrick’s The Shining. The MRI was uneventful.”

He continued:

“As with Stalin’s 5-Year Plans, the pace of my medical procedures accelerated as I got closer to a transplant date.

“On Monday (the 14^th), we had to be in at 6:30 AM for a procedure to insert a central venous catheter with 3 lumens (the proprietary name is Trifusion, but I call it King Ghidorah, after the ludicrous 3-headed Japanese movie monster that appears to shoot arcs from Tesla coils) to facilitate the harvesting of stem cells…

“At 10:30, I was instructed to have blood work, and then we had to wait until 6 PM to get an injection of Mozobil, which is designed to promote the creation of stem cells (it is very expensive, so the pharmacy only makes it at 6, and only if the patient is present).

“That left 7 hours to sit in the hospital to get a single injection. I decided to play a literature game, inspired by Woody Allen’s film Love and Death, in which 2 characters converse using Dostoevsky novel titles (e.g., ‘They say he was Possessed.’ ‘No, he was an Idiot.’).

“As a patient and medical editor, I have dealt with absurd drug titles that lend themselves to bad literature. With apologies to Sophocles, here is my one and only Greek tragedy (those not in medical education may want to skip this section).”

[Note from Annie: All the names below refer to medications or medical procedures; I’m assuming Peter had endured each one.]

“In the city-state of Amlodipine, known for its high level of education and culture, King Azacitidine and Queen Romidepsin rejoiced at the birth of their son, Granix. According to custom, they brought the child to the Temple of Invokana. 

“They were alarmed when the high priestess Apheresis prophesied that Granix was destined by the gods to be the worst playwright in history. 

“They tried to avoid the prophecy (not recommended in these plays) by sheltering their son and home-schooling him. 

“When they died, he was unaware of the prophecy until the soothsayer Carmustine revealed the curse. Terrified, Granix changed his name to Zarxio and fled into exile.

“He decided to avoid his fate by settling in the city of Thiazolidinedione, whose ruler, King Actos, forbade all education and culture. 

“Soon, however, the city was besieged by the dreaded monster Mozobil, who tormented the population with riddles such as ‘How do you spell your city’s name?’ ‘Is the word ‘data’ singular or plural?’ ‘Is ‘health care’ one word or two?’ In desperation, King Actos issued a proclamation for anyone to rid the city of the monster. 

“Displaying his hubris, Zarxio stepped forward and answered all the riddles, and then drove Mozobil away by challenging him to explain why ‘nonadherent’ did not have a hyphen. Instead of gratitude, King Actos wondered why Zarxio knew so much, in a city where being educated was a crime. 

“Eventually, Etoposide of Amlodipine, who had been searching for Granix, heard about Zarxio’s exploits. Etoposide explained that Zarxio is an alternate form of Granix, unmasking the criminal. 

“For defying the will of the gods, Granix was banished to the realm of Polypharmacy, where, in a drug-induced stupor, he churned out the worst plays of all time.

“The moral: It is better to play with your cell phone than to try to write a Greek drama.“ 

Peter provided considerably more detail about what he was experiencing, and then wrote:

“Now for the reason this is such a long SNAFU. The current plan is for me to enter the hospital next Tuesday or Wednesday… In order to ensure the complete response, for 6 days I will receive a very strong chemotherapy called BEAM…, which is associated with serious adverse effects.

“ If nothing else, my multiple regimens (Hyper-CVAD, CHOP, ICE, clinical trial, and soon BEAM) will make me a connoisseur of chemotherapy.

“After 1 day off, I will have the transplant and continue to stay in the hospital for about a month. The SNAFU Sequel will be on hiatus.

“I am sure that when I return there will be numerous hilarious episodes to recount. With a recovery period that may last a year, the SNAFU Sequel will inevitably become a tome.”

He then observed:

“The hospital neighborhood, which I have noted is a nightmare of construction vehicles, iron plates, and gridlock, has a few surprising areas of calm as well.

“Across the street is an armory where I ran track while in high school, providing me with an unintentional foundation for surviving lymphoma. 

“One block west, the traffic noise cannot be heard.

“Instead, you see a veritable United Nations of medical students with their youthful exuberance, quizzing each other and giving one some confidence in the future, as opposed to our political situation. 

[Here he expressed his profound gratitude and love for his wife and appreciation for his friends—and then became philosophical]

“The Tao Te Ching, perhaps by Lao Tzu (Laozi), contains an often misquoted statement, with the true meaning close to ‘The journey of a thousand begins beneath one’s feet’ (obviously, they did not measure distance in miles 2,500 years ago). 

“However, my own path has comprised many paths. A better way to sum up my treatment journey is a quote from the Pirkei Avot, compiled about 2,000 years ago:

“‘You are not obligated to complete the work, but neither are you free to desist from it.’

“So off I go to the big city, with Kander and Ebb’s ‘New York, New York’ ringing in my ears.”

……………………….

At his wife’s suggestion, I had planned a phone call with Peter shortly and a visit once he was out of isolation. Peter died on November 19 at age 65. He left his body to science.

His wife referred to him as her “brave warrior.” Though he was a peace and social justice advocate, her words seem apt in terms of how valiantly he fought to remain on this earth.

I learned many things from Peter, and one of them was the extraordinary intelligence of rats. Yes, rats.

Peter requested that anyone who wanted to make a contribution in his memory send it to Apopo, a non-profit organization that trains African giant pouched rats to save the lives and limbs of children and others by detecting landmines that are buried in more than 60 countries that had been at war. The rats can also detect tuberculosis, which is often otherwise undiagnosed and therefore deadly. Thus, they are called HeroRATS.

I’ll end this post by borrowing Peter’s typically Peter closing. I find its generosity of spirit, in view of his own circumstances when he uttered these words, nothing short of remarkable.

“I hope you all have wonderful times and holidays ahead. Remember to laugh!”

Annie