A Man among Millions

Today was my last day as a Specialist Leader at Deloitte Consulting. It was a special day. I got to be the emcee for ONC's all-day session on health information exchange at their annual meeting in DC. It was a day spent with people with whom I have been working for the last three years from all over the country -- many with whom I had worked shoulder to shoulder as I traveled to more than a dozen states to help them develop and execute on their strategic and operational plans for health information exchange. 

More and more I'm being asked to facilitate meetings. I try to bring some energy to the day and add some of my creative juices to the conversation -- through a song or a story or something new. These last few weeks, I've been so busy with Kym's health and my transition from Deloitte to AMIA that I didn't have time to think about doing something special for this meeting.  

Then last week, I had the privilege of spending three days with members of our armed forces at Aberdeen Proving Grounds on the Maryland coast at an "Innovation Deep Dive" session to develop innovative strategies for targeting tobacco use among our enlisted ranks in all the branches. There I met HN Taylor Mickal, a young hospital corpsman in the Navy who also happened to be a spoken word poet. We asked him to write something for the meeting and he shared an amazing piece with us the next day called Dive Deep. His poem inspired me to try my hand at free verse -- something I'd never really approached before.

Over the last 24 hours, I wrote this piece and was honored to be able to share it with some 200 HIE warriors at the end of the day. I am so grateful to ONC leaders Claudia Williams and Erica Galvez for giving me the opportunity to share a day with people I hold in such esteem. And am even more grateful for the way they received this piece.

Thank you for doing this important work.

A Man among Millions

tick tock

check the clock

it's moving faster

relentless

in its quest 

to stop us in our tracks

can you hear it?

faster than my beating heart

thumping with anxiety

checking for the reaper

over my shoulder

who's on a bender

hell-bent on the hunt
to take down those I love

tick tock

time won't stop

or take a break or hesitate 

to cut us off at the knees

yet here we stand

for what we believe 

can make a difference 

if we only make it flow

today we stand for flow --

for what we know is essential to the health

of this thing we call a healthcare system

we stand for flow

for overcoming the inertia of standing still

pushing information out 

transforming it from solid state to liquid gold

letting it go where it needs to go

...flowing into the chasm separating us

from the quality we pay for but don't receive

...flowing so the liquid data 

cascade and echo 

making ripples of insight

that concatenate to create tsunamis of knowledge

and so we organize ourselves

into exchanges

every state and territory

building its own story 

of how to make this work

in local circumstances

taking chances with taxpayer dollars

that we could never afford 

on our own accord

trying to fix on a massive scale 

the brokenness of our system

that we in our confessed complacency 

have grown to see as normal

millions --

nameless, faceless

suffering under the burden

of a system uninspired 

to go the extra mile --

are saying enough

I have a name

I have a voice

I have a face

I take a stand

here I stand

just one example 

of a man among millions

with a family lost in this maze

with a father who died

from cancer of his phantom prostate

that had been removed twenty years before

no PSAs for twenty years

why test for something long removed?

maybe because there's a chance it's not all gone

maybe the data are all there to know the answer

of whether it would have made a difference

this one simple test

here I stand 

just one example 

of a man among millions

with a family lost in this maze

with a mother slowly losing her way

keeping the memories of her youth

but forgetting those formed an hour ago

her children 

long away from their hometown

trying to connect the dots of her care

by remote control

"help! I've fallen and I can't get up"

doesn't reach to Atlanta or DC

so we rely on old technology of phone and fax

which isn't up to the task

as she rides 

from assisted living

to hospital

to rehab

and back again

while her medical records struggle 

to keep up the pace

here I stand

just one example 

of a man among millions

with a family lost in this maze

with a young son who enjoys good health

but has already faced the surgeon's scalpel 

at an age too young for his memory to recall

exactly why he has that scar on his back

or how his kidneys lack the full capacity

others take for granted

how will he know 

when he comes of age

what this means for him

his records passed down

from his elders

like an oral history

told around a campfire 

after a hunt for mastodons

here I stand

just one example 

of a man among millions

with a family lost in this maze

with a wife who bravely faces

cancer number three

in thirty years

who alone carries the burden

of coordinating care 

among the dozens and dozens

of providers who focus on

the particular part of her they understand

who alone carries the records

from place to place

from year to year

from diagnosis to diagnosis

hoping she can keep it all straight

so at the very least they do no harm

here I stand

one of the lucky ones

a man of means

with coverage

with knowledge

with friends

who stands helpless

to make the system work

for those who are the world for him

here I stand

in a room of my heroes

who possess amazing superpowers

to bend maze corners

into straight corridors

and change the flow

from a trickle 

to a torrent

I don't presume to know what drives you

what compels you in the morning to forego

another fifteen minutes sleep

and return to the battle

to do the heavy lifting

to add another line of code

to write another line of policy

to sign up one more to join the exchange

to solve one more problem

to make one more connection

to make it flow

but if you need a story to motivate

to steel your resolve to press on

mine is here and free for the taking

still better

forget my story

and tell your own

shout it from the rooftops

or whisper it only to yourself

but keep that picture

sharply focused in your mind

to give you the inspiration

to do the work

so we all can be 

one among the millions

whose information flows

Decisions, Decisions

Clearly, I am not a dedicated blogger. After sharing a string of posts on Kym's cancer journey, six weeks came and went without a peep from me or a peck on the keyboard for this blog. But those six weeks have been anything but mundane. Kym is recovering beautifully from her initial surgery and is feeling great. She continues to focus on the full-time job of deciding on and preparing for her treatment path.

Her path has not been straightforward. This is more because we are in the enviable position of having options -- something we know many who face a cancer diagnosis don't get to enjoy. The findings from Kym's pathology reports and the additional biomarker tests have been, for the most part, very encouraging. She has Stage IB ductal cell carcinoma, which means that the cancer, though locally invasive, has not spread beyond her breast tissue. Her sentinel node biopsy showed only microscopic cancer and is considered node negative for staging purposes.

Chemotherapy would be a standard option; a few oncologists would recommend watchful waiting at this point. Kym has been working with Donnie Yance, a master herbalist in Oregon (www.mederifoundation.org), to develop a botanically based protocol to optimize her health and create a cellular environment that is not receptive to tumor growth. After many discussions and consults, a great deal of personal research, and much prayer, she has decided to postpone chemotherapy.

Just a sample of the biomarker studies Kym obtained on her cancer profile

I've thought about what I would say in this post for quite a while and it's frankly gotten no easier with time. While I have some misgivings about Kym's decision, I am also completely supportive of her decision. There are a couple of reasons for why I feel as I do. The rationale for her decision is well reasoned, so I don't think Kym is just eschewing traditional medicine because she is being naive or ill-informed. On the contrary, she has maintained an openness to whatever options make the most sense for her. At the same time, Kym is not just accepting whatever the doctor says; she is the personification of an engaged patient. And she has long understood the benefits of complementary approaches to health through her 30-year experience as a cancer survivor and her training as a certified holistic nutrition consultant.

I've attended or have listened in on as many of Kym's consults as possible. She's received excellent if not sometimes conflicting advice. Donnie's knowledge of tumor markers, current research on treatment protocols, and the effects of botanicals on the human body is truly impressive. I cannot find fault in the level of scholarly research he has personally done to arrive at his recommendations. In all of this, I feel very much the novice and, like most people, have to rely on the recommendations of experts and trust that they are bringing unbiased perspective to the table.

Still, I know my own comfort zone. I trust allopathic medicine because it is what I know. I also know its limitations and that it is subject to its own biases. How many promising therapies have come and gone when the initial clinical evidence prompting FDA approval prove not as demonstrable in everyday clinical practice? And how many times have we later learned that commercial interests shaped the initial evidence?

So I remain uncertain of which path makes the most sense. If it were me, I would have gone the "traditional" route and subjected myself to a year of chemotherapy, with all of the attendant challenges. But it's not me. It's Kym. And that's the second reason I support her decision, because the decision is ultimately hers to make. In truth it's the only important reason for my support.

Kym has also decided to go ahead with a mastectomy on the currently unaffected side. She is among a growing number of women who are choosing this option of a prophylactic mastectomy -- removing the breast tissue before there is evidence of disease. Most oncologists will tell you that the evidence for such a decision is not clear. We've also seen them quickly agree that it is a reasonable choice for Kym because of the mantle radiation she received in the past, making her risks for another breast tumor in the future even higher. So just after Christmas, Kym will have her second surgery.

More Decisions

This whole experience has given us reason to pause and consider some broader issues of how we are living our lives and how much time we are carving out for work versus family. I have been on a fairly high-intensity career track for the last dozen years -- first at Pfizer, then in management consulting at BearingPoint and Deloitte. My four years at Deloitte have been fascinating and, for the most part, very enjoyable. But it is an intense and somewhat relentless place. Performance expectations are high, as are the rewards.

Back in September, the day after we learned about Kym's diagnosis, I was on a call with Jonathan Grau from the American Medical Informatics Association -- my professional association -- about an industry survey on health informatics we were jointly publishing. On the call, I shared my news and Jonathan shared his -- he was leaving AMIA. Minutes after the call, he texted me: You should seriously think about taking my job.

Then the day after that I got a call from a good friend with whom I had been considering partnering for many years. He indicated he was ready to take the plunge and have me join his small but growing band of folks. Within a couple of weeks, I was staring at two unsolicited job offers.

Three, really, as Deloitte leadership had made it clear that they would be willing to work with me on whatever arrangement made sense for me as Kym went through treatment: work from home, focus on business development or eminence -- whatever would work best. But Deloitte is investing heavily in informatics, having recently acquired Recombinant Data, and is building a formidable federal strategy practice. I know myself and the way the firm works; it would be extremely hard to keep myself from being pulled into the middle of these important endeavors.

In the end, the decision was pretty simple. I needed more balance and a more focused career for a season. Staying at Deloitte, I would be like a kid in a candy shop who's supposed to stay on a strict, low-carb diet; and my friend's offer was great, but it was also in the consulting realm, which wouldn't really change the dynamic of what I do for a living.

So on 12/12/12, I will start my first day as VP of Corporate Relations and Business Development at AMIA. AMIA has over 4,000 members, but only 15 (and as of next week, 16) staff members. It's a role I can get my head around and something I feel comfortable doing. No doubt, there will be pressures of a different kind in this role. The AMIA board has high expectations for the growth of the organization and rightly so. I personally believe that this is the time for the informatics profession to experience a real transformation.

Our need for good data, information flow and better clinical decision support is real and more critical than ever. That information needs to flow not just to researchers and clinicians, but to the people receiving treatment and to their loved ones and caregivers who are invested in their health. I feel that need on a very personal level every day.

The Sling is the Thing

We saw Kym's plastic surgeon, Dr. Doug Forman, on Monday (one drain down, one to go!). One of his staff members commented on how they recommend their patients wear a sling, but most don't heed the advice.

I bought this $12 sling at CVS for Kym after her latest breast biopsy. Then as now, it has really helped keep Kym comfortable postoperatively. It is easy to put on and take off, is reasonably stylish ("Black is always in fashion" according to Kym), and helped remind her to keep her arm to her side even after the immediate pain subsided.   

Plus it makes a great pity bandage! People know to hold a door and to avoid giving you a tight squeeze when they say hello. Maybe it can also get you out of a speeding ticket if you really work it (though I'm not sure it will show up on one of those dastardly speed trap photos).

And can I just say how amazing my wife looks? I never grow tired of gazing upon her beauty...

Love Delivers

Like many folks these days, we have a home phone that receives many more calls than are answered as most calls are of the telemarketer / political campaigner sort. But we've been answering more calls this week... and the door... and email as friends and colleagues have been pouring out love and concern.

We have been so grateful for these thoughtful gifts and words of encouragement. They have indeed lifted our spirits and have reminded us that we are not alone in the struggle.

Perhaps the most touching gift of all was the basket full of cards we received from our son's 6th grade class. T started attending a Christian school this year as he and Kym have both recently become Christians and are building deep ties with the faith community. T's class spent a whole period working on cards that included a Bible verse of encouragement. Each one was a cherished reminder of God's love and care for Kym.

To all who have reached out with flowers and words of support and encouragement, thank you! To  those who have offered to make food, we're working on that! More later.

Happy Birthday to Me

There's just no denying it -- today was not a birthday full of celebration. I like birthdays all right and am not particularly afraid of uttering my age (48) or of getting older. I still feel like I'm just getting started and, other than the occasional back problem stemming from high school marching band (I was a 5-foot tall bass drummer) and my recent need for reading and driving glasses after enjoying 45 years of perfect vision, I feel fortunate to enjoy excellent health.

My biggest age-related shocker came a year ago when I met Katelyn, one of the new analysts at Deloitte. Analysts are usually campus recruits -- landing their first job out of college. Some quick mental math brought me to the realization that Katelyn was born in 1989, the year I delivered my first baby in med school.

During the five years I did obstetrics, I delivered around 600 babies and most of them seemed to be named Katelyn or some variation on the theme. There were some in-vogue boys names too -- like Conner and Max maybe -- but Katelyns were popping up more often than Super-PAC ads in an election year. And their parents honestly thought that they were being so creative naming their new baby girl. I didn't have the heart to tell them that their daughter was the third Katelyn of the day.

So I'm standing in front of this very grown up, professional Katelyn -- a colleague -- trying to keep from admitting myself into an assisted living facility. And I confirm that, yes, she was born in 1989. I could feel the Alzheimer's setting in. Since then I've met at least a dozen Katelyns (Kaitlins, Katies, Caitlins -- they're all the same) running around Deloitte pretending to be adults when they've barely had enough time to be potty trained. And the real pisser of it all is that they really are adults.

So I don't mind so much that my birthday this year was overcome by recent events related to Kym's breast cancer. Kym has been doing remarkably well. She's off her pain meds and is only taking a muscle relaxant to help with the discomfort related to the expander. Still, she's moving slowly and, following yesterday's cooking marathon, has been decidedly pooped. After making an appearance at church, she spent most of the day napping. Which was fine since Kym and I had already celebrated last weekend when we attended the wedding reception for friends Harry Greenspun and Kerry McDermott -- where this picture was taken. We got a room on Marriott points and danced the night away, knowing that it would be a while before Kym was ready to cut a rug again.

Instead, I took Taylor out for breakfast and that was pretty much the extent of it. In fact, the only way I could really tell it was even my birthday was from the many nice emails and notes on Facebook I received. A number of those notes included acknowledgements that they knew far too well what I was going through because their spouse was going through the same ordeal.

It struck me that I am now a man of a certain age where friends, loved ones and colleagues are starting to get hit with those medical issues for which they seem far too young to be eligible but are actually just early adopters on an inevitable curve of far too commonplace ailments.

Let's hope for the sake of all those Katelyns out there that all those walks and races and other fundraisers for the cure have their desired effect so that no twenty-something woman need fear that they will someday have to miss celebrating a birthday because of a disease, but will be blissfully ignorant of what it means to have breast cancer.

That would be the best birthday present ever.

Breast Cancer Couture

Kym and I made a quick stop to see the plastic surgeon the day after Kym's mastectomy.  We wanted to make sure her Jackson-Pratt drains were working properly as one of them seemed to be blocked. Everything was working fine and we got a chance to take a quick peek under the dressing to see Dr. Forman's handiwork. The site looked great. We had been concerned about the integrity of Kym's skin since her tumor has infiltrated the skin's surface forcing her surgical oncologist, Dr. Wright, to make a wider skin resection than we hoped. Thankfully, Dr. Forman had the necessary room to spare to insert an expander, which he will gradually inflate with saline to stretch Kym's skin in preparation for her permanent implant when the time is right.

With her post-operative harness and two drains on her side, I thought Kym looked like a bustier-wearing gunslinger...

Drains aren't too much fun to manage, but they are fairly simple to handle once you get the hang of it. Just as you can find a video on YouTube for learning how to do everything from French braiding hair to wrestling alligators, you can find videos for how to care for a JP drain. I put in a few of these drains during my brief stint as a clinician and was comfortable with them, but seeing how to handle them on a video can really help the uninitiated.

Kym and I are committed to chronicling our experience on this cancer journey. There are many directions I can imagine going with these posts -- from providing perspective on the caregiver experience to delving into the emotional side of it all. Our goal is to be helpful to others on the journey and to help ourselves keep perspective through our own. If you have thoughts about what you want to see here, please share.

Kym's Drive-By Mastectomy

In my brief career in obstetrics (in the early '90s), HMOs were coming into fashion. The big patient advocacy kerfuffle was all about "drive-by deliveries" -- where the HMOs were pushing to get new mothers out of the hospital in 24 hours.

How times have changed! Kym's 7:30am mastectomy and the first phase of reconstruction went off without a hitch. She rolled out of the OR before noon and we rolled into our driveway at 4:30pm -- exactly 11 hours after we arrived at Suburban Hospital in the pre-dawn darkness.

Our surgeons both encouraged us to go home without an overnight stay if we felt ready for it. Kym never had a Foley catheter -- they just told her to call if she couldn't void by 8pm.

But in contrast to the cost-constraint HMO mentality of the '90s, the focus was all on quality and outcomes optimization. The routine use of catheters in surgery ends up increasing the risk of infection. And spending more time at the hospital increases the risk of hospital-acquired infections too.

It turns out that quality care and cost-effective care aren't necessarily mutually exclusive.

We were thrilled to be home eating our own food and pampering Kym. We couldn't be happier with the care we received from the physicians and staff at Suburban. They focused on getting the job done and treating Kym with respect and care -- including respecting her OCD issues (more on that another day).

We are home, Kym is enjoying her meds, and we are so very grateful for the prayers and support of friends and colleagues.

No Nodes is Good Nodes

What could bring a smile to the face of a woman whose breast has just been surgically removed from her chest?

Hearing your surgeon say, "Your nodes are negative."

Kym is sore, sleepy and very happy. Definitive pathology results will come in a few more days, but we have every reason to believe that Kym's cancer has not spread beyond her right breast.

My bride will be coming home with me very shortly.

The Waiting Place

You can get so confused
that you'll start in to race
down long wiggled roads at a break-necking pace
and grind on for miles across weirdish wild space,
headed, I fear, toward a most useless place.
The Waiting Place...

...for people just waiting.
Waiting for a train to go
or a bus to come, or a plane to go
or the mail to come, or the rain to go
or the phone to ring, or the snow to snow
or waiting around for a Yes or a No
or waiting for their hair to grow.
Everyone is just waiting.
Oh, The Places You'll Go - Dr. Seuss

I sit in The Waiting Place as I type this post. Not a figurative one, an actual Waiting Place -- one of the Waitiest, Weightiest Waiting Places of them all.

I sit in the waiting area of Suburban Hospital in Bethesda, MD as Dr. Pamela Wright removes my wife Kym's right breast and Dr. Doug Forman begins the process of replacing it with something that cosmetically approximates her breast. 

At this particular Waiting Place moment, I am waiting for the news of whether Dr. Wright finds metastases in Kym's axillary lymph nodes to go with the infiltrating ductal carcinoma and two areas of ductal carcinoma in situ (DCIS) that were found by ultrasound-guided biopsy on September 11th. That little bit of information, determined by frozen section of her sentinel lymph node, will determine whether Dr. Wright will go further with her surgery and resect two of three layers of Kym's axillary lymph nodes and whether Kym will need to add a course of radiation to her planned chemotherapy.

For those of you still trying to decrypt that last paragraph, here is the sum of it:
The love of my life has breast cancer.

My few years of taking care of patients as an obstetrician/gynecologist gave me a sense of what it is like to watch someone hear the word "cancer" for the first time. Once that word enters the room, it sucks the meaning out of all other utterances, making it difficult to process anything else.

For us, the word's impact is a little less dramatic if only for its familiarity. If you have read any of my other posts on how Kym and I met, married, and "made other plans," you will know that cancer has been a central theme in our lives -- especially in Kym's as her current breast cancer completes her carcinoma trifecta that includes Hodgkin's Lymphoma (in 1983) and melanoma in situ (2004). We know the word cancer is a scary word, but it is not all-powerful, nor is it necessarily an absolute death sentence.

So we wait -- she lying on a surgical table in a dreamless, medicated slumber and I in the relative comfort of the waiting area a few hundred feet away.

We have decided that a good therapy for us will be to write about the journey. We know that the story, however it unfolds, will both help us sort out our feelings and will perhaps give others some perspective as they experience a similar walk through the shadowy corridors of uncertainty and angst. Our own journey has been made less anxious by the postings of people like John Halamka and his wife Kathy as he dutifully chronicled her journey through breast cancer over the last year.

This particular Waiting Place wait is almost over; Dr. Wright will soon come out with the news of how Cancery Kym's cancer is. Then we will enjoy another wait for the more definitive pathology report and then the recovery wait and the chemotherapy start wait and many other waits beyond. But we are not focusing on the wait; our minds and hearts are on the moments that fill the waits, those Magical, Meaningful, Matterful moments that make life worth living.

HL7 Announces Free Standards

Back in 2006, I was one of three final candidates to be the first CEO of HL7.  My big push in my final interview was to advocate for changing HL7's business model to make HL7 standards free for use.  I strongly believed that doing so would present a short-term risk as the organization transitioned from relying on membership and license fees to trusting that a different kind of sustainability model that didn't include license fees would still work for the organization.

Dr. Chuck Jaffe was ultimately selected to be CEO and remains so today.  I was disappointed in not making the cut, but knew that he was an understandable choice by the board.  This morning, Chuck made an important announcement: HL7 would indeed be transitioning to a free license model for all of their standards and much of their intellectual property.

The announcement to members is below.  I couldn't be more thrilled!

To the HL7 Membership: Today, the HL7 Board of Directors committed to licensing its standards and other selected HL7 intellectual property free of charge. This policy is consistent with HL7’s vision of making our collaborative and consensus-driven standards the most widely used in healthcare, and with our mission of achieving interoperability in ways that put the needs of our stakeholders first. Our primary aim is to maximize benefits to our members, the healthcare community, and all those who have contributed to make HL7 standards so successful. The implementation of this important decision requires careful planning and due diligence, which is expected to take several months.  The policy will go into effect after analysis of input from our members.  We would welcome the opportunity to discuss this with you, and to gain your insights and suggestions for moving forward. In order to provide clarification of several critical issues, please go to the following link for a detailed FAQ document: http://www.hl7.org/about/faqs/FreeIP.cfm A global press release explaining our plans will be issued at noon EDT today. HL7 members are also invited to attend one of two webinars scheduled this week in which I will discuss these plans and give our members a chance to ask questions.  Members are invited to send their questions in advance of the webinars directly to our Director of Membership, Diana Stephens at Diana@HL7.org. The webinar information is listed below: ·         Wednesday, September 5 at 11:00 am EDT. Please register at https://www2.gotomeeting.com/register/973015242 ·         Thursday, September 6 at 4:00 pm EDT. Please register at https://www2.gotomeeting.com/register/263054898 We recognize that our members are the backbone of HL7 and we look forward to continuing our partnership with you,

Behold, the Power of Twitter

Behold, the power of Twitter! I arrive at a store at 6:55pm to grab an essential item for #HIMSS. Door locked, employees inside ignoring my pleas. I type the following the following message on my iPhone: "Employees at #[NameofNationalChain] in Germantown decide to close early and won't let me in the store." Held my phone against the front window and knocked until one of them finally came over to read it. "Don't make me hit send," I say through the glass. Two minutes later, I'm out of the store with my item.

On Life and Making Other Plans

This is the last of a three-part posting about my dance with the love of my life, my wife Kym. You may want to read Part I, Shall We Dance?, then Part II, Romance, Meet Reality, and see Regina Holliday's post on the remarkable Walking Gallery paintings she made for us.

Our Wedding Day - Summer Solstice 2000

John Lennon's famous quote--life is what happens when you're making other plans--aptly describes our experience shortly after we exchanged vows on Kaua'i's Shipwreck Beach as the sun set behind us. We had quickly fallen in love with The Garden Island and had worked out a five-year plan that included the goal of owning homes in Boston and Kaua'i so we could experience the best of both worlds.

That five-year plan lasted about two weeks.

We came home from our honeymoon to the news that Kym's stepfather--a man I never met because Kym was no longer on speaking terms with him--had died that very day.

His funeral was held in Canton, CT (where Kym grew up) just a few days later. It was a very strange and sad event.  Strange because most every conversation we had in the receiving line went something like "I am so sorry for your loss... and congratulations on your marriage!" And sad because there wasn't a single person among the few who attended the service who was sorry to see him go. They dug up a drinking buddy to do the eulogy and the one remotely positive thing he could say of Kym's stepdad was that he was smart.

But, as Kym had already told me, he used his intellectual powers more as a weapon than a force for good. I got to see this firsthand as we sorted through his meager personal effects with Kym's mom and found a pile of editorials--written for no apparent purpose other than his own amusement--that were full of misogynistic sentiments and spiteful words shrouded in clever turns of phrase. We read a sampling before throwing them all in the trash.

The funeral was a painful way to start our marital bliss. As we returned from Connecticut a couple of days later, Kym felt physically and emotionally spent.  Her significant difficulty walking up the stairs to our second-story apartment was inexplicable given her commitment to personal fitness.

Even though she hadn't yet been "late," I thought she should check the box and get a pregnancy test. Two lines. An OB friend loaned me the keys to his office so we could get early ultrasound confirmation of her positive test. The grainy image of a tiny sac left no doubt about the result--or the timing of conception... our wedding night.

Putting all of the pieces together, we ultimately figured out that the Pill had been the culprit causing many of the symptoms that led to Kym's C/T scan... that led to the (incorrect) diagnosis of a recurrence of Hodgkin's Lymphoma... that led to our decision to set a wedding date sooner than later... that led to that magical evening on the beach. The Pill had also thrown off her schedule so she had no idea our wedding night was right in the middle of the baby-making window. Clearly, Kym's radiologic oncologist had succeeded in preserving her fertility.

I had already started down the path of finding a urologist so I could get "snipped" about three weeks after our wedding. Some say our son's conception during that brief window of opportunity was fated; others say it was an act of God's will. Whatever the source, you could make the argument that the vehicle for either option was the Pill--a conclusion made even more ironic by the fact that I was trained as an OB/Gyn.

Understandably, this seminal news left us stunned. The deer-in-headlights sort of stunned. It took us a good bit of soul searching to figure out what to do with this fork in the road. We hadn't looked at each other with the co-parenting lens for longer than it took us to laugh at the absurdity of it. Now we had to look deep into our own hearts and make a decision about something for which neither of us were truly prepared.

In the end, it came down to some simple calculus. We went to a local golf course--Kym had been giving me lessons on one of her greatest passions--and talked through it all while strolling though that idyllic setting. We concluded that, as much as we weren't ready to be parents, having a child could be an incredibly healing and enriching experience for us both. We knew the opportunity to share this particular journey together would almost certainly never come again.

So we chose to accept it as a gift and prepare to take a whole new direction. Gone were my visions of being a "kept man" so I could work on longer-term goals, inventions and creative works. I needed a "daddy" job with health insurance and a steady paycheck.

The pregnancy had its difficulties, with some early tests indicating that all was not well and some emotional challenges for Kym as she struggled to fully embrace motherhood during her pregnancy. All our concerns were assuaged when a very healthy, 10-pound 2-ounce Taylor used his well-developed lungs to let us know he was more than okay and none too happy about his emergence.

Fast forward almost 11 years. Kym and I have had our rough spots. Our marriage has been far from perfect and there have been at least a couple of times when we wondered why we were together at all. Today I can say that Kym and I are both happier than we've ever been--not just since our wedding day, but in our lives. Though I wasn't looking for a "real" job--I've found a meaningful and rewarding career in shaping the future of healthcare in my consulting work. It is demanding, but it still leaves room for family and creative pursuits. Kym has had time to focus on raising Taylor, completing her MBA at UConn, and, in the last several months, finding peace in her new-found Christian faith. And Taylor is thriving--blogging about his inventions, making increasingly impressive videos, and becoming a Black Belt in karate. We both continue to become more whole as individuals--my geek side would say we're asymptotically approaching wholeness--and Taylor has been a profoundly important part of our personal journeys.

What started as a passionate romance has grown into something even more powerful--a family.

Thanks, Regina, for inspiring me to look back at those early years so we could appreciate where we were when we started and how far we've come.