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What is the perfect university? What is the perfect student? Are students who attend elites schools really just 'excellent sheep'?A lot of people think they know. My Ngoc’s words should give many an education about perfection and stereotypes about students. They will also educate many about courage, inner strength, and the ability to overcome the odds. Embedded in this answer are some words My Ngoc has already shared on Quora that hundreds have found useful.********************************************************************My Ngoc at age 41. Where did you grow up and where did you go to secondary school?I grew up in a quiet suburb in Northeast Atlanta called Lilburn. My high school was a large public high school of about 3,000 kids called Parkview High School.2. Were you always a star student and how would you describe your approach to learning? Are there some areas you particularly love?For as long as I could remember I had been either the top or one of the top students in my classes. My family moved to the US in 1992, when I was 1 year old. Since they only spoke Vietnamese at home, I didn't get to practice my English so I was in ESL classes until the 3rd grade. The moment I got out though I was transferred to the gifted program. I don't know if I have an approach to learning. I've just always been very curious, and it helped when my teachers made subjects seem very interesting. I remember in the third grade (everything happened in the third grade), I would go to the library every day and check out nonfiction books about all sorts of animals. I never really had good study habits, since I just kind of soaked in information as I thought about things. I love writing. I love science. I love art, and anything creative. I've come to see science and art as intertwined disciplines, both of which show the beauty of the universe.3. How did you decide which schools to apply to? How many did you apply to? Did you do anything special like SAT prep? How helpful was your college counseling office?Honestly, I didn't even think about applying to any Ivy League schools until I noticed that my friends were applying to them. And I thought, if they're applying, I would probably be just as competitive of an applicant. Both of my sisters went to schools in Georgia though, so I thought I would just be in Georgia. I applied in total to UNC Chapel Hill, Georgia Tech, University of Maryland, Princeton, Yale, Brown, U Chicago, Columbia, and Harvard. I got into all of them except for Yale and was wait-listed at Princeton. (I remember I tried to suck up to my interviewer by telling her that she looked like Alicia Keys, and I don't think she was too pleased.) I applied to Harvard last, just on a whim, because the application was pretty simple. I didn't do any SAT prep--just got a book and taught myself. Our teachers were good at giving some SAT prep every now and then though. I remember the point when I realized that the SAT was all about--just knowing how to think, and that's when I was able to get good scores. I really didn't talk to my counseling office at all. My parents didn't go to college. I didn't even realize that we had counselors at our school, just kind of did my own thing and got lucky that I did the right things.My Ngoc with parents at high school graduation4. Did you have a mentor or a teacher at school who was particularly inspiring to you? If so in what way did he or she change you?Yes. One stands out to me now--Ms. Huie, who was my English teacher my sophomore year of high school. She was the one who saw my gift in writing and encouraged me to develop my talent. She taught me how to think critically, and not blindly. And with her support I submitted my writing to a national competition and received a National Writing Award. She taught me to work hard at what I love, and allowed me to get a glimpse of what it's like to live up to my potential.5. You are one of the chosen few who ended up at what most consider the top university in the US so many will be interested in what you did to get in. Could you talk a little about the kinds of courses you took, the kinds of activities you were involved in and if at all possible the things you chose to talk about in your essays (if you’d be willing to share your essays this would of course be even better).Freshman year was magical. I was at the best school in the world, in an exciting new city, and I was in love too with a boy of my dreams. I took classes about gender theory (which was quite exciting since I came from a rather conservative, southern town), religion and existentialism, visual theory (I love the VES department), and a graduate seminar on French colonialism (I learned so much about Vietnam and was really proud of my 20 page paper on the role of Vietnam's Latin alphabet in the formation of its modern identity). My world was expanding in ways I never thought were possible. On top of school, I comped and got into The Crimson, The Advocate (literary magazine), WIB (Women in Business), and WHRB (the radio station--I was in the jazz department). I think for a short while I even worked with the Small Claims Advisory Service and found it to be wretchedly boring, so I quit. I also volunteered with a Boston Refugee Youth Enrichment Program where we mentored Vietnamese immigrants. I quit that too because I felt like that the programs were a waste of time, not giving much to the children, and ultimately hurt them more because it is sad to see mentor after mentor leave you after a couple of months. If I wanted to do service work and be good person, I can just be nice on a daily basis. I took a gap year after freshman year due to mental health reasons. When I came back, I dropped all those activities besides the Advocate, but I do not regret comping them, since the comp process is very educational. Just the jazz comp taught me so much about essential jazz artists and jazz history. Sophomore year I produced a play that my boyfriend at the time wrote. I also started a comics club with my friend, and we published a comics magazine every semester called The Crunch. Since then I've stayed committed to the Advocate, managing my own club, and doing research at a sleep lab at Beth Israel Deaconness Medical Center (I ended up majoring in psychology, and this research in neuroscience was so so cool!).As for what I wrote on my college application essays, I wrote one about bras--it was a long analogy about how the increasing complexity of the bras I wore, from basic sports bras in the fifth grade to the fancy frilly cupped bras in high school, corresponded to the increasing responsibilities and burdens I had growing up. The other essay was something about penguins and breaking the ice and learning that I could fly underwater (instead of on land) after reading a certain inspiring book. My admissions officer wrote me a personal note saying she really enjoyed the bra essay.6. Why did you decide to enroll at Harvard?I really wanted to go to Columbia, but they gave me no money. Brown was okay, but didn't give me as much money as Harvard. So it boiled down between going to Harvard on a 30k scholarship or going to UNC on the Morehead Cain Scholarship. I had visited UNC before and felt like going there would be a repeat of high school (big fish in small pond). I also knew that I was insecure and needed to be comfortable with who I was, and being surrounded by all sorts of stars at Harvard would force me to do that. I also didn't know anything about Harvard other than that it was Harvard--this looking, golden, glittering promise of vast success--and that seemed too hard to give up. At first, however, I declined Harvard and said yes to the scholarship. For the next week though, I couldn't sleep or eat because I felt like I had made the worst decision of my life. So I called Harvard and asked them to take me back. They said yes, and then I told the scholarship committee at UNC that I would be declining the scholarship. They were really mad at me since I had already signed the contract, and for a while I thought I was going to go to jail.********************************************************************Note: What follows is the answer that My Ngoc wrote in answer to this question that was posted a while ago here on Quora.comHarvard University: What is Harvard really like?I can only speak for Harvard College.Harvard is a very extreme place. You go there and everyone is extremely smart, extremely driven, extremely focused on attaining his or her goals. It is so extreme that it can become scary sometimes. When you have a bunch of people with high intelligence, but who are not necessarily mature or moral, you can get some pretty nasty results (that's how you get so many insecure, bright students going into Wall Street to make a lot of money even though it's screwing everyone else over).Even the clubs are extreme. You don't just write for the newspaper. You have to go through a semester long competitive process to be selected into the Crimson. And after that, if you want to do well in the Crimson, you have to work your ass off and neglect your studies to be considered a true trooper. Kids here consider their extracurriculars a job. All social interactions have some sort of shady networking pre-professional slime to them.A lot of students are really full of themselves. They spend all their time climbing the ladders of success and trying to win everything. Everyone is super busy all the time. You have to arrange lunches with your friends about two weeks in advance.Harvard is not the type of place where you backstab your friend, but if your friend fell in a race, you would keep on running and not bend down to help. Students, for the most part, are only interested in their own benefit and will do things that look good, rather than things that are good.But then again, there is the other extreme too. There are people who come to Harvard, not because of legacy or money, but because they are genuinely interested in the truth. I've met people who are so gifted at their focus, whether it's poetry, writing comic books, musical composition, or biomedical research, and they work on these things night and day. They thrive in the guidance of their professors, and I have faith that they will make a meaningful contribution someday. I try to stick to those people.If you ask any student what they think about Harvard, most will say that they hate it, but that they found a great group of friends who keep them sane. Those who really really really love the place have some serious mental problems--either in that they are super disingenuous or are psychopaths, or are there really only to network and join the super elite circles of final clubs and whatnot.Harvard is still a very elite place. You will feel out of place if you are anything but a white male. You will feel a bit uncomfortable if you come from a normal middle class family, because bit by bit you see just how much money your fellow peers have.You will realize that Harvard doesn't care about you. Professors have office hours, yes, and they say to come, but their heart is not into it. Everyone at Harvard is there for their own benefit, for their research and for advancing their careers. Occasionally you will find professors who genuinely care, but they are the exception.I knew going into Harvard that it wouldn't be easy, that Mother Harvard does not coddle. And I was right. It has been hard as hell. And it's sad to learn the truth about Harvard. But truth does make you stronger, and I would not be as strong as I am today if I didn't gain these hard lessons from my undergrad years.-----------------------------------"Freshman Year my roommate and I won the Annenberg cooking competition. She made dessert and I made the entree-Thai Peanut chicken sliders".Notes:It's been a week since I first posted this answer and I've been pretty surprised (and kind of happy) at how many people it's reached. Here's some more thoughts after reading and replying to people's comments:- I'm not trying to label Harvard as "good" or "bad." Just that is has a lot of good things and a lot of bad sides. It's obviously up to you to make your experience a good or a bad one, and multiple commentators have said that.- I don't hate Harvard, and if allowed to I would go there again, albeit I would do it differently knowing what I know now. It has given me many good things (amazing research opportunities, friends, experiences, blah blah blah). The other answers already touched on that though and I didn't feel like being repetitive. Instead I tried to show that it is not the perfect brochure Harvard that most people have in mind. I focused a lot on the bad extremes because I know that's what people crave to hear about.- No, I don't actually think that everyone who loves Harvard is a psychopath. I tried to be as objective as possible, though I am still human and swayed by my emotions. I didn't think much about my word choice because my writing just came out as a rant. But does everything I write have to be factually true?- I'm also not trying to say that people can't and shouldn't have a good time at Harvard. A lot of people's comments have said that they had a great time, and I'm happy for them. I had a particularly rough time in my three years (that I would wish on no one), and that exposed me to a lot of the uglier sides that many of my friends have not had to face. I am glad, though, that there is so much discussion. Reading people's comments has expanded my view as well. It's good that we're having a discussion, and discussions are more fun when people have ranging opinions.- I wrote this answer with no other intention then to educate as best as I could. I wrote it because sharing is caring. I'm sharing my experiences and thoughts so that people who go to Harvard can know at least know what to expect so that they can be spared any painful surprises.So there. Hope this makes things clearer.********************************************************************7. Your experience at Harvard should be educational to many. It is a wonderful school, but that does not mean it is a perfect place by any stretch. If you had to do think about what you should have found out before you enrolled that you did not, what would those things be?I wish I could have known just how cold it would be. I wish someone would have told me to buy a down coat. I wish people would have told me how different sophomore year and freshman year would be. They coddle you like crazy as a freshman with all these mentoring programs, and then come sophomore year you are left to sink or swim on your own. I wish I could have known that the high-pressure environment would make my childhood depression spiral out of control. And I wish someone could have prepared me for the immense culture shock. I had no idea what consulting was, what investment banking was, what hedge funds were.My parents are nail technicians. I come from a very humble background, and a very small and nurturing environment. My universe expanded so quickly and I had very little to hold onto, considering there was no host family and I didn't know anyone in Cambridge already. I wish someone told me not to be in a serious relationship my freshman year because then I would have been able to bond more with friends (and that guy ended up cheating on me with 13 other girls over three years anyways). BUT, going to Harvard has made me so much smarter. And while it's tough, it pushes you to be better than you ever thought you could be, that is, if you don't break under the pressure, which I almost did. Being a Harvard alum also gives you a good connection base that can last a lifetime. All trade-offs. Pick and choose what you're okay with.8. If you were to give advice to parents and students about the college search, and the college choice what would you say?You have to decide what you want out of college. If the first four years is just a way to get a degree, then any college will do. But if college is a chance for personal development and self discovery then in this case it would be useful to go to a school where you will be surrounded by an excellent peer group and thought provoking professors. You also have to know what type of environment allows you to thrive the most. You should choose to go somewhere where you would feel supported, have the room to grow, and be surrounded by good academic resources.Pursuing a big name like Harvard might not be worth it if the environment is toxic to you. I admit that Harvard's environment is kind of toxic for the type of person I am, but I do not regret going there at all. To me, college is a time for development, and I've certainly developed in leaps and bounds over these past four years. I started out as an out of control, confused, excited freshman, and now I'm much more aware of who I am and what I want out of college, out of life."Me and my blockmates take a photoshoot in Harvard Square freshman year. We stayed friends throughout college. Freshman year I got my bangs cut."9. What do you think you want to pursue after graduation?My dream is to be a child and adolescent psychiatrist. I care deeply about mental health and want to help fight against the stigma against mental health and to prevent suicide. My other dream is to write books.My current project is to write and illustrate a children's book about fairy tales from Vietnam. I think these traditional stories have a lot of lessons to offer the world about the value of humility, loyalty, and perseverance. They also offer a different sort of delight than the Western children's stories I know. I was lucky that my parents taught me a lot about Vietnamese culture, and I think there is a growing need for Vietnamese-American children to be in touch with their rootsI've already written one book (albeit self published) called The Washing Room in 2013 about my experience with depression. It has helped many people gain strength and courage to speak about their own mental health experiences, and I would say that was the highlight of my accomplishments so far. My story has a happy ending, and I think stories like that need to be shared. Nothing makes me happier than being able to use my words and experiences to help, inspire, and provide hope for others.Anything else you want to add?Nope! If you made it all the way down here, bravo! I just wrote a novella.********************************************************************I am grateful to My Ngoc’s willingness to share her experiences here. As she makes clear her experience it Harvard is not what all students go through. On the other hand, the atmosphere at elite schools these days have come under a lot of critical scrutiny.Over the last several weeks, there have been many stories written about whether it is a good idea for student to enroll in an elite school. At the moment, the leading critic of elite education is William Deresiewicz. His book, Excellent Sheep: The Miseducation of the American Elite and the Way to a Meaningful Life, takes aim at the elite schools in the US.His critique extends beyond the Ivy League; it encompasses highly selective schools and a large swath of the secondary school communities that have turned getting into these schools into process that starts, in some cases, before birth:When I speak in this book of elite education, I mean prestigious institutions like Harvard or Stanford or Williams as well as the larger universe of second-tier selective schools, but I also mean everything that leads up to and away from them: the private and affluent public high schools; the ever-growing industry of tutors and consultants, test-prep courses and enrichment programs; the admissions process itself, squatting like a dragon at the entrance to adulthood; the brand-name graduate schools and employment opportunities that come after the BA; and the parents and communities, largely upper middle class, who push their children into the maw of this machine. In short, our entire system of elite education. Deresiewicz, William (2014-08-19). Excellent Sheep: The Miseducation of the American Elite and the Way to a Meaningful Life. Free Press. Kindle Edition.Many publications and individuals seem to have taken much of what Deresiewicz says as definitive proof fall in lock step with the stereotypical description of the student bodies at elite schools. Both My Ngoc and the data do seem to support some of Deresiewicz’s critiques:“The numbers he does cite are damning. For example, 36 percent of Princeton’s class of 2011 went into finance alone, while the twin sirens of finance and consulting claimed about half of Harvard’s class of 2010.”The New York Times has joined in recently:“The trouble starts at admission. Top universities woo thousands of teenagers to apply, but seek one defined type: the student who has taken every Advanced Placement class and aced every exam, made varsity in a sport, played an instrument in the state youth orchestra and trekked across Nepal. This demanding system looks meritocratic. In practice, though, it aims directly at the children of the upper middle class, groomed since birth by parents, tutors and teachers to leap every hurdle. (The very rich can gain admission without leaping much of anything, as Deresiewicz also points out.)”Each year the percentage of students getting into the top ranked schools drops. Applications keep rising but the number of spots do not. Many students are "guided" by parents or force themselves to try to fit an impossible ideal.My Ngoc is not one of those students who fits into this description. She was not born into the elite. Her parents worked tirelessly to rise from poor immigrants (and My Ngoc worked tirelessly alongside of them too.). Her story is not as rare as Deresiewicz’s opening salvo might lead readers to believe. At schools like Williams, for example, the percentage of first generation students is far higher than at many less selective schools. Harvard and others with huge endowments also offer greater financial aid packages than many other schools in the nation. The leaders, by far, of elite schools enrolling low-income students are Berkeley and UCLA. (For the reasons why this is and why they receive so little positive press for this go here. Deresiewicz barely mentions these schools in his book.) About 20% of the students at Harvard are Pell Grant eligible, a key indicator of low income. While ths is not a huge percentage there are still a significant number of students who are receiving aid.And yet while what I have just written may be accurate, it is also necessary to say My Ngoc found the income and class issues significant. In other words it is true that there are class issues and it is also true that there are far more low income students at many elite schools than most people think. The ones who are now often being squeezed out of the entering classes of selective schools come from the middle class, since admission spaces constitute a zero sum game.Those with high incomes often live in areas with great public schools or send their children to private and boarding schools. These students get access to top counseling, SAT prep and a whole lot more. It is no surprise that they often stand out in the admission process. They have worked hard for it and also had opportunities others cannot afford. My Ngoc represents one of those who rose to the top largely by her own efforts. She was lucky, however, to find a great mentor in high school and the effects of mentors is dramatic.Recent articles and Deresiewicz too underscore how important mentors can be to students. At elite institutions, however, faculty members are not rewarded for mentoring. Instead, they must continue to publish or perish in order to get tenure and in order to climb up the ladder to full professor. My Ngoc’s experience with professors should be noted by those who think that by going to elite institutions they will be chummy with Nobel and Pulitzer winners.One thing that virtually every student at elite schools agrees on--the competition in and out of class is intense. Students must compete with others who are exceptionally talented and driven. I have underscored what Malcolm Gladwell and others have said about competitive schools before but it bears repeating. The most competitive schools are not for everyone But what I would like to emphasize here is that any book or article or blog entry that purports to demonstrate what students as a group are like on a college campus skips individuals and will, therefore, leave out the stories that call into question the usefulness of an overarching thesis about students at any school. In previous entries, I have interviewed many students who talk about their experience at their schools. All of them are different because they provide details. But all of them have something in common—the words they share are inspiring for students. Anyone reading them can learn there are lots of ways to succeed and lots of ways to learn from challenges too.Most recently, Kate’s entry on her experience in the Plan II Honors program at UT is now linked to their website. Her words demonstrate how these students are anything but excellent sheep. So too, with Ryan’s entry on her experience at Oberlin. She had a tough time for a while but now is exploring writing and women’s studies and a lot else because she loves to learn and write. And then there is Zara, a student from China at Harvard, whose words about her great experience there have gone viral in China.Each of these stories demonstrates an individual experience rather than an overall perspective that applies to all students. Assigning rubrics like “excellent sheep” that attract headlines works well for selling books, but it if a student had written such unsupported generalizations in a paper submitted for one of my classes they would have received some comments about learning to support these words with more solid data and detailed interviews. There are some data and words from students in the book but not enough, at least for m to say the vast majority of students at these schools have not examined their lives at some Socratic level I know many students at elite who do ask the hard questions of themselves and the world,( and some of these are now on Wall Street or consulting). Elite schools educate many students to think about thinking and being. They do change lives in great ways more than what many reading the current spate of articles might think.I am glad, therefore, The NY Times piece, mentioned above, does, contrary to almost every other review of Deresiewicz’s book, call him to account for over generalization too:But anyone who cares should also know that the coin has another side, one that Deresiewicz rarely inspects. He describes the structures of the university as if they were machines, arranged in assembly lines: “The system churns out an endless procession of more or less uniform human specimens.” Yet universities aren’t total institutions. Professors and students have agency. They use the structures they inhabit in creative ways that are not dreamt of in Deresiewicz’s philosophy, and that are more common and more meaningful than the “exceptions” he allows.I mention all this because My Ngoc’s story does not fit into the simplistic dystopian vision of elite schools. Schools have spent untold millions recruiting students who are not from elite private schools. They have put money and a good faith effort in trying to diversify. Have they succeeded in creating a utopian campus in which the percentage of students mirror the demographics of the US by income? Not by a long shot, but they have tried and to some degree succeeded in creating a grand social experiment in which great students from all over the US, the world, and all income groups do live and learn together. But that still does not mean that at the end of the day those kids with 20 APs, 2400 SATS, global service and experience still won’t stand out. For those who have not yet heard, life isn’t fair, but IS schools, more so than than most other places around the globe, try to use a holistic approach to admission and do emphasize a liberal arts education.It is true that My Ngoc beat the odds. She, by her intellect, exceptional writing skills, and the help of a mentor or two found a spot at Harvard. But as her words demonstrate, her story is far more complicated. For her she found that Harvard was not a perfect fit. But this too was a valuable experience in the log run as she now prepares for a career that will help others who have troubles. She has both the intellectual acumen and real world experience to bring to those who can learn from her. I have already learned about her courage, her incredible writing voice, and her desire to turn what some might consider a disaster into a “fortunate fall”.My Ngoc describes what she has written above as a novella, but the words she shares are true to her experience. In a subsequent entry I will review her real book, The Washing Room, which I think many should read, given what I have quoted above from articles about the atmosphere at elite colleges today. Too often people say college will be “the best fours years of your life” . For some this may be true (although is so I think it is kind of sad given the life expectancy most college attendees have), but for others it is anything but.The process of getting into the elite schools has become far more selective, far more complicated, and far more fraught with pressures than there have ever been. My Ngoc’s words in her interview and in her book should be both cautionary and reassuring. Students finding themselves “under pressure” should learn that their struggles are not terminally unique and not something to hide from those who can help. They also serve as a cautionary tale for any writer hoping to lump into groups a large number of individuals into a simplistic rubric whether it be "excellent sheep" or "elitist rich kids" or something else.“We are our stories” and these stories contain infinite details and experiences. My Ngoc’s story has given us a view into her own unique world. For this I am grateful. What she has shared here should change some minds about a lot of the unexamined premises about education on elite campuses. I know those reading my upcoming review of her book will find her stories may help far more than incendiary articles about the big questions in life.

I was very arrogant about my health until recently.At 59, I had never been sick, I’m very fit, and look quite a bit younger than my age. My father is 90 and lives the same lifestyle now as 30 years ago, living in his own home in the Texas Hill Country.I’m a physician and have almost daily occasions to offer health advice, and I have a healthy, thriving practice.I am a fan of Nortin Hadler, MD, who writes extensively on intelligent, informed healthcare, offering facts and studies a healthcare consumer should be aware of before giving or refusing consent to commonly recommended medical screenings and treatments for conditions such as high cholesterol, blood pressure, or glucose; colonoscopy; mammography; PSA screening and more. Lest you think he’s fringy, he’s Professor Emeritus of Medicine at UNC School of Medicine at Chapel Hill, and Harvard and Yale educated. You can see his brilliance and relevance in this PBS interview.For 20 years or so, I’ve seen a wonderful internist yearly, but, would abdicate responsibility for this behavior, saying. “The only reason I have a doctor is I have a wife.”Thank goodness I have a wife.September, the year before last, 2018, I had previsit labs for my annual visit with Rick Earnest, who was Chief Resident during his internal medicine residency at Emory, he’s top notch.My white count was low. Rick’s nurse called and said he wanted another CBC and a folate. White count low; folate normal.Then, I saw Rick in his office and we chatted dispassionately about the neutropenia… WBC was around 2, with 4–12 being normal.He told me he had talked to a local heme/onc that morning and then, he shrugged his shoulders and said, “Looks like you need to see a hematologist…” I agreed.About a month later, I had extensive labs at the local oncology center; met the delightful hematologist, Kavita Nirmal, who recommended a bone marrow biopsy.I knew this was coming and, once again, being very healthy and having no signs or symptoms, I thought serial CBC’s would do.However, after my consult with Kavita, I had no urge to refuse the bone marrow biopsy, and it was done that day.Things moved quickly from there.The next day, Kavita called and said I needed to see a specialist at Baylor. Five minutes later, she called back and said, “You could also go to MD Anderson.”Baylor is two hours, MD Anderson is four.Initially, I balked at accepting an MD Anderson referral, as this meant, in my mind, saying, “This is serious.”Over the next 24–48 hours, I had the strong intuition I should go to MD Anderson.I responded to Kavita’s phone call about my treatment choice in a way I found funny/odd… I said, “I owe it to my family to go to MD Anderson.” I thought, “Wow, Dude, you can’t even take responsibility for your choice to go to MD Anderson.” (It wasn’t a big deal… but, interesting.)My records and actual marrow specimen were Fedexed to MDA; I went there for labs and another bone marrow biopsy; and met with a national leader in leukemia, Naveen Pemmaraju.All this occurred in a very compressed period of time and in a context of general surreality, punctuated by briefs periods of extreme surreality.I had accepted there was something wrong with my bone marrow. I had actually been aware I was neutropenic as far back as August 2016; but, again, arrogant invincibility had me ignore it.In Longview, I was told, based on microscopic evaluation of my marrow, and an estimated 13% blast count, I had myelodysplastic syndrome (MDS), something I was familiar with when a fellow staff psychiatrist told me he had it. It was a significant health scare for him, but that was in the 90’s and he and I were in touch for at least 10 years after that, and to my knowledge, he’s still fine today… (we both moved on from that mental health center years ago).Then, as I was going through the process leading up to seeing Dr. Pemmaraju, a nurse who was checking me in and reviewing my chart, was reading out loud to herself… as I listened, it was all quite routine to me as a health care provider, until the letters “AML” came out of her mouth.They weren’t intended for me; she was just one of those people who reads out loud when they read. Perhaps she thought I knew. Perhaps she didn’t know she was reading out loud. It is a cancer center…I can’t think of an adequate adjective to put in front of “stunned” and “frozen” to adequately express that instant as the biggest WTF! of my life rang out in my mind…“It’s leukemia?! I have leukemia?!!!” My mind was reeling with that shock…It was quite a mental shift, in an instant, unsuspecting, unprepared, from MDS to AML.I suppose it was helpful to have the time to be past that initial reaction later, as I sat in one of Dr. Pemmaraju’s exam rooms, waiting to see him. He burst into the room almost as enthusiastically as Kramer on Seinfeld. He was young, energetic, positive and extremely enthusiastic.There I was, sitting face to face with one of the finest allopathic physicians… a hematologist/oncologist who only treats two types of leukemia and MDS.It was a briefly challenging/confronting situation on a philosophical level.You see, I’ve been writing, Power Without Pills: A Curious Psychiatrist’s Guide to Healing and Growth in the Modern World since Googling John Sarno, MD in February 2006. And, I have talked some trash about modern medicine. Not irresponsibly or inappropriately… but, trash talking nonetheless.I was challenged with substantial, in-my-face cognitive dissonance.I resolved it for myself quickly.I had been throwing the baby out with the bath water.I had been all “mindbody medicine is where it’s at!” and, then and there, I realized I had been going to an extreme.I once heard a man say, “You’re just as half-assed no matter which cheek you got.”So, I decided, “Alright... I like this guy... I trust this guy... I’m going to roll with this, and I’ll handle the mindbody part... and he’ll handle the traditional medicine part…”Both cheeks were suddenly firmly in place.He told me they have a clinical trial, using the CLIA protocol, where they’re getting upwards of 90% complete remission rates in frontline AML.All three drugs are FDA-approved for AML, but no one is using all three together. “We are gonna rock this thing! We are going to crush it together!”, he said, beaming.He told me I’d need some preliminary tests, like an echocardiogram, to qualify for the study... a formality.Then, I would be admitted, given five days of chemo, be in isolation, and have a total of around 28 days inpatient before being discharged to outpatient treatment where I would receive five consolidation rounds of the same three chemotherapy drugs every 28 days.He said I’d be in complete remission by Day 28.That conversation was on the Friday before Thanksgiving. He told me to go home and spend time with family... my wife was there in that initial consult and throughout, but I hadn’t seen my father in Austin in a while... it was a wonderful, deeply meaningful break/visit with close family before I went inpatient… ostensibly 28 days, in isolation.On the eve of Thanksgiving Day, I was admitted to the Leukemia Specialty Care Unit at MDA, at around 7 pm, and began chemotherapy that night.How I’ll be bathing in isolation for the next 3–4 weeks…My wife and father-in-law visit me in the square bubble…This woke me up in the middle of the night, tickling my nose…Going…Gone. My hair didn’t survive.It went exactly as he said; except I had a Day 21 bone marrow biopsy in the hospital. The next day, the attending on the service strode briskly into my room, smiling, and said, “Go home. You don’t need to be here any more.”My blast count had gone from 30% to 4%, complete remission, in 21 days.I said, “Uh… I’m not ready.” (My wife was four hours away and expecting me to be discharged in about a week).I went home the next day, six days early, for good biological behavior.I was in complete remission.There was suspense though. I was told through some magic called flow cytometry, they could give a measure of prognostication, MRD, Measurable Residual Disease. With MRD, they could find traces of leukemia, the presence of abnormal blasts, “down to levels of 1:10,000 to 1:1,000,000 white blood cells (WBCs), compared with 1:20 in morphology-based assessments.”[1]A few nervous days later, at my first outpatient follow up, I was given the news, “You are MRD negative.”A Senior Coordinator of Clinical Studies, Department of Leukemia, MD Anderson Cancer Center, Rabiul Islam, who’s worked there since 2003, gave me that wonderful news, and he added, “I have never seen an MRD negative patient at Day 21.”As I have said, I highly value and practice mindbody medicine; parts of that are a positive mental attitude and faith in the healing propensity of the body and the intelligence of life.And my positivity and faith had been rewarded at every turn (even developing leukemia, which I would not have consciously asked for); but it was never the kind of faith and positivity that produced a reaction to, “You are MRD negative,” of, “Well, of course, I’m MRD negative.”I cried when he told me and it brings tears to my eyes now as I write this. I am deeply grateful.And, along those lines, I have taught mindbody medicine concepts for over 20 years and was pleased to find nothing changed with being diagnosed with an illness that has a 25% five-year survival rate. I found, not surprisingly, I walked the talk. Yet, you don’t know how solidly your ship is moored until there’s a storm.As interesting foreshadowing, for years, as one approach to mindbody medicine, I would discuss the hypothetical situation in which someone was diagnosed with a type of cancer that had their physician say, “The 5-year survival rate is 5%.” I would then say, “I wouldn’t say, ‘Oh, no! Those are terrible odds!’ I would say, ‘What did the 5% do?’’’ (My apologies for the complex, and possibly incorrect sentence structure.)I have had many profound blessings in the powerful life lesson leukemia brought to me.To address the question:The leukemia was caught on a yearly routine blood test before I was symptomatic.I am young and healthy, with no comorbid illnesses, and I really stood out on the Leukemia Specialty Care Unit because of my youth, fitness, and lack of comorbid illness.I got the best cancer treatment in the world, I assert.I’ve had an excellent attitude throughout.I never fought the leukemia. I was never inclined to. At the local cancer center, the narrative was everywhere about fighting cancer; even the wifi password had that rhetoric… yet, I could not abide by that narrative.I’m not suggesting that people not adopt that narrative; it’s fine with me if they do; it’s just not for me. I’m not going to start a “Fight Fighting Cancer!” campaign.I do want people to know there’s more than one narrative to adopt in the face of cancer. Pick according to your gut.I’ve said thousands of times: “What you resist persists.” I would not fight. I would listen.I viewed the leukemia as a messenger, and my job was/is to get the message.I have enjoyed Louise Hay’s work, and was aware of the fact she gave meaning to particular illnesses.I thought, “Leukemia is a childhood disease…” Hmmmmmmm…I had started guided journaling at What is Self Authoring? many months earlier, and had started with the Past module (there are also two for the present and one for the future… starting with the past made the most sense to me…) but, I quickly fell into procrastination…One obvious message was, “I wouldn’t do that if I were you…”, meaning, I got one message as, “Don’t keep putting off deep work.”Now, acute myeloid leukemia is relatively rare with about 20,000 newly diagnosed cases a year. That’s an incidence of 0.006%. It’s rare.But, things would likely be much darker (which sounds weird to write, because I can’t say they’re dark (though I can admit if one looks at the five year survival rate for AML, one would be inclined to say they’re dark… but, that’s a statistic, and part of good mindbody medicine is not being negatively influenced by stats…)) if I hadn’t been getting yearly routine labs.TLDR:Get yearly routine labs like a CBC and complete metabolic panel.The risk/benefit ratio argues for it.Think of it as insurance… you definitely want to have it, even though you don’t want to use it.Extra credit edit:So as to exclude as few readers as possible, I am adding an important point…I have used the word, “blessing” more than once, and said that there is meaning in this life challenge/lesson, thereby asserting/strongly implying it’s not random; we don’t live in a strictly mechanical Universe, in which we humans are machines that break and consequently go to doctors that intervene on our behalf and restore us to health.I was ultimately convinced of that mechanistic worldview until the age of 23. I no longer believe in or inhabit that worldview… but no matter…I’m working on a reply to the gentleman’s comment in which it’s asked what I think caused the leukemia.My reply involves logic I learned from my mother, an adept at logic. She changed her worldview late in life with logic.She told me one day, she had done a thought experiment in which she made a matrix of cells… the particulars will be in the reply when I post it.It is the particular thought exercise that’s relevant here:Let’s say you can’t abide by the notion of an actual blessing, or the idea there’s meaning to be mined in a disease, especially a life-threatening one like leukemia, you can still potentially get the value of that system/belief through this exercise:Let’s construct a matrix of four cells: 2 rows, 2 columns…I’m blessed really/I’m not actually blessedI believe I’m blessed/I reject the possibilityThen stand in each cell and look out at the world as if those conditions are so… what do you see? Is that possibility empowering?You see, it isn’t the truth that I was blessed and it isn’t the truth there is meaning, not randomness, in the leukemia… it’s a powerful place to stand.For the strictly “If I can’t see it in a lab, it doesn’t exist,” Do you want to be empowered, or do you want to be right? Or, if your health isn’t good, do you want to be healthy, or do you want to be right?Consider everyone is a house with four rooms: physical, mental, emotional and spiritual.In the modern world, you risk falling prey to the paradigm, the physical level of reality is all there is… It’s all matter and energy… if you can’t see in the lab it doesn’t exist.That worldview may be true, and obviously, it may not be.If you hold yourself as a house with only one room, physical, which gives rise to the illusion of the other three rooms and that’s not the case, there may be a dear price to pay.EDIT (April 16,2019):I can’t say I’m about to add materially to my answer of the question; however, I can see how the reader might be curious as to what’s up as of today… I don’t remember when I wrote this; I see my last update was February 16th.There have been three excitements and one very sad loss since I last updated. I’ll end with the loss.About six weeks ago, after receiving a unit of red blood cells, an infusion which took about two hours, I drove home and sat on the couch. I started to feel cold and hot at the same time. Cold won out and I got underneath an electric blanket and turned it on. Very shortly I was having hard chills.My instructions from MDA since my December discharge were, “Go to the ER if your temperature hits 101 or more.” I didn’t have to take my temperature. My wife drove me to the ER. It was a Friday afternoon and the ER was packed. Getting into the ER was fun; because I have staff privileges there, but the staff up front and the triage nurse don’t know me from Adam. So, I went in the back doors of the large ER, bald, with an overnight bag slung over my shoulder and said, “I’m Dr. Murphy. I’m in treatment for leukemia and I have a fever.” Most of the dozen or so doctors, nurses, technicians and unit clerks behind the counter stopped what they were doing to stare at me. I stared back at them. Eventually, a nurse broke the deadlock. “17 is open,” she said stepping out to escort me.I was deathly ill. All the routine things… blood cultures, chest xrays, etc. were done, looking for a possible source of infection.For the next three days I lay in the dark, sleeping as much as I could. They left me alone, which I thought was odd, but appreciated. At MDA I don’t think they would have let me lay in the bed 24/7, and didn’t even when I had RSV (another story).Monday rolled around; nothing had grown in the blood cultures; and, I had started to feel better. About 11 am, having enjoyed a great rapport and relationship with everyone there, I said politely to the nurse, “Um, I’m going to be discharged. I just need to know whether it will be AMA or not.” 10 minutes later I was signing routine discharge orders, and I went home. I felt like crap.In retrospect, the most likely explanation was a non-hemolytic transfusion reaction, something that occurs in about 1 out of every 1,000 RBC infusions. This can occur if WBC’s stow away in a batch of inadequately washed RBCs. They cause a cytokine reaction, the kind of thing that makes you feel awful when you have the flu.Gradually, over the next few days, my energy came back.The second excitement was going back to MDA on a Friday, my chemo rounds always start on Friday, and had labs in the morning to prep to see Dr. P, who would then order the 3-day round of chemo.My WBC was below 1,000, even though, due to circumstances, I was on Day 35 of a cycle. Being in a clinical trial at MDA, there are protocols and guidelines and chemo was off; it couldn’t proceed.Once again, Dr. P predicted the future. He said, “We’ll do a bone marrow biopsy; you’ll still be in remission. You’ll go home. Have a great weekend. Come back Monday morning. We’ll do labs and give you a shot of Neupogen Monday and Tuesday mornings, and we’ll restart your chemo on Wednesday.”That was an exciting weekend; because, while the blast count was likely ready Friday afternoon, no one was there to read it. And, while I mentioned a couple of potentially arrogant sounding behaviors around febrile neutropenia hospitalization; I’m not the type to be inclined to try and get the results before Monday.I was able to think positively throughout most of the weekend. I did allow my mind to think about a recurrence, but not to dwell on that possibility. I wasn’t in denial; I knew the results of the biopsy could be bad news staying alive-wise. But again, I mainly stayed in positivity and continued to visualize my 90th birthday party (my father, Stu’s 90th birthday party is next month) and to affirm, “I am so happy and grateful now that I’ve released the patterns that gave rise to the leukemia.”Monday morning, after having had my labs, I was sitting and waiting in the 8th floor leukemia waiting area, waiting to be called back for an injection of Neupogen, my cell phone rang. It was Dr. Islam. “Your blast count is 2%.”I cried with joy, once again, as I did when he told me, “Your MRD is negative. I have never seen an MRD negative patient at Day 21,” months before.To be continued… fatherhood calls at the moment…there’s more coming… and… 95% of what I write on Quora is via iPhone… somewhat constraining…My two older sisters and I with our father at his 90th birthday party last month, May 2019. He’s a huge inspiration, and not just because that’s his house we’re visiting and he’s had CLL for ten years and has only accepted monitoring of it.I’m coming up on 6 months complete remission. There’s much more to write; and, my commitment is that what I write make a difference for you.And, as promised above, there’s more to the story and I will flesh out what I believe made the difference in the face of a potentially terrifying disease…Today, my hair, like springtime blossoms, is sprouting again… a sign of the life force, irrepressible, pushing up through the cracks in the sidewalk…Here’s to New Life……and again, more to come…Edit: July 4th, 2019Today, the 4th of July, enjoying Life. I’m 60 now… my hair’s sprouting… the sprouting started this Spring after the chemo was finished… I gave that timing meaning… Springtime… new life…I intend to share more about this experience, and yet, I’m not sure this is the place to do that given the original question.So far, it has been a pleasure to have this forum to share my experiences with leukemia and everything related. If you have a suggestion as to a better forum/platform to share my knowledge, experience and hope with regard to leukemia, let me know.EDIT Saturday, July 27, 2019:I had surgery Thursday to have a myringotomy and tympanostomy tube placed in my left ear. It went perfectly.Fluid filled my left middle ear during my last hospitalization (for febrile neutropenia) in April. There were two complications from that hospitalization, I presume from high dose IV vancomycin and cefipime… a sudden and persistent left ear effusion and neuropathy of my distal feet bilaterally.The tube has all but resolved the effusion (it’s present in the morning, but drains within and hour or two). And the neuropathy, which consists mainly of the sensation my socks, no matter what their fabric, are filled with sand in the toes, and there is pain at times, increased initially with hard shoes and jogging. However, the jogging actually seems now to be a force for its resolution.I set a goal of running a 10K by September 29th, a goal RunKeeper helped me to decide on. Thanks to my varsity tennis playing son, Elliot, for that app tip.I had preop labs Tuesday, and coincidentally, two month followup labs for my heme/onc, Kavita Nirmal, on Wednesday. Not surprisingly, they were both very close…WBC 4.1Hgb 16Platelets 157,000It’s all good.EDIT Thursday, September 12, 2019:Reporting in for the curious…My post above starts with the yearly routine labs I had done September of last year, 2018. That’s cool, and relevant to the question.I’ve had two haircuts since my nuked hair decided it was OK to start growing again. Gone is the childhood fear of the barber or stylist getting it too short.I’ve run 5 days a week since July 21st, and I am registered in Texas Oncology’s Celebrate Life Survivor’s 5K on the 28th.There are two big benefits of running 5 days a week.One is the health and fitness benefit which is enough on its own.The other is, who I am for myself today is larger than who I was when I was saying, “I need to start running again,” for SEVEN years. (I was shocked about 4 months ago, in a moment of self-clarity, I caught myself running that line of bullshit past myself, and I stopped and asked myself, “When was the last time I exercised regularly?” …2012. Damn, Dude. You’ve been saying that to yourself for SEVEN years.)About 3 months ago, I started making the bed if I were the last one out. I’d heard Dr. Jordan Peterson recommend this one before solving any of the world’s problems. “Make your bed.”About a month later, during breakfast with my varsity tennis playing son, I downloaded an app, RunKeeper, he’s using to log his many runs.It started pressuring me to run a 10K in a month. I reacted, “I’m 60 years old. I’m not running a 10K in a month… I’ll run one in two months,” and on July 21st, I started running 5 days a week.Another recent shift in who I’m being in the world is manifested by the fact that I’m writing again.UPDATE: September 30, 2019I beat my oncologist in a 5K this weekend! Sorry, Dr. Nirmal. Good run!Not that long ago, my hemoglobin was 7 and I got winded climbing a flight of stairs. Now it’s 17 and I can run a 5 kilometers!UPDATE: October 25, 2019:It just occurred to me it is getting close to the one year mark that I went to MD Anderson for the first time and I don’t think I’ve adequately acknowledged them.To me, and probably by objective measures, MD Anderson is the best cancer treatment center in the world. It must be one of the largest with over 20,000 employees and over 15,000,000 sq ft of space. Yet, it is one of the best run organizations I’ve ever seen of any size. That’s important. But, not as important as the care and concern I saw everywhere. The ethos there is healthy, upbeat, nourishing and inspiring.In particular, I want to acknowledge and thank to a depth appropriate to one given to someone who participates in literally saving a life. Naveen Pemmaraju, thank you for saving my life. I am the father of a now 3-year-old, precious boy. I am also the father of two other boys, 19 and 17, who shouldn’t lose their father, either; yet, the biggest save was saving the life of the father of this precious 2-year-old boy.December 13, 2018 - Just discharged from MD Anderson’s Leukemia Specialty Care UnitThis is what I’m talking about, Naveen. This is such a huge gift. Words aren’t adequate to express the depth of my gratitude. Thank you.Rabiul Islam, thank you for your relentless close support and encouragement. You repeatedly went above and beyond calling me on my cell and keeping me informed. And, the moment you told me I was MRD negative is one of the happiest moments of my life. You didn’t have to add, “I have never seen an MRD negative patient at Day 21.” But, you did and that made a deep, profound positive impact. It has been some of the best medicine mentally and emotionally, and probably physically and spiritually. All boats rise with the tide. What a profound gift. Thank you.Michael Andreeff, thank you for who you are personally and professionally. You were my first inpatient physician contact, and it was, interestingly, on Thanksgiving Day. You walked into my room with an entourage of residents and fellows and said, “Who are you, and vot are you efen doing here?” (Sorry, that’s my recollection of your delightful German accent.) I loved our banter. When I told you I was a psychiatrist, you told me, “I vanted to be a psychiatrist, but I vound up being this.” You were part of the development of flow cytometry in the early days in Heidelberg. Flow cytometry told me the leukemia was gone down to a resolution of 1:1,000,000 WBC’s compared to 1:20 resolution possible with a microscope alone. Thank you for the quintessential physician that you are; and, thank you for having me look forward to witty banter every morning at morning rounds. What a delight.Zeev Estrov, thank you for who you are. Two memories stand out. You came into my room the morning after my Day 21 bone marrow biopsy and said, “Go home. You don’t need to be here anymore.” And, after I started to recover from the seeming near death experience from RSV, I perked up for your morning rounds; and, you and your entourage of residents and fellows came in. I had finally had a good night’s sleep and told you so. You turned to your students and said, “That! will tell you more than any lab test.” To me, such a brilliant moment of teaching. In medical school, I remember the lesson of one of my professors, “You treat the patient, not the labs.” You are another star in the MD Anderson firmament.To the staff of the 12th floor Leukemia Specialty Care Unit and to the nurses who inserted my PICC line, I cannot say enough to thank you and express the gratitude I have for my treatment there. It is a difficult thing to be a young man, otherwise healthy, diagnosed with a life threatening disease and facing an uncertain future, knowing it included, at the least, chemotherapy and weeks of isolation. I don’t think I’ve told anyone this because it sounds weird. When Dr. Estrov told me to go home on Day 22, I was disappointed. That’s partly your fault. Good job. I’d say, “Keep it up,” but that would be silly. It’s who you are.To the 8th floor Leukemia Clinic and staff, thank you for always being friendly, upbeat, professional but not dry or stiff, and always being a well-oiled machine. Wow. You and your clinic and lab are part of the reason that the thought occurred to me, “This is the best run organization I’ve ever seen of any size.” Amazing. Thank you.To my individual nurses, inpatient, outpatient and chemo, because all of you were so extraordinary in skill, compassion and presence, I got to be right every time about how great MD Anderson is, every time. Every contact. Thank you.To the nurse who put in my PICC line, when I was the most alone and scared, Wednesday night, alone before Thanksgiving Day, thank you for your flawless insertion of a central line, your calming bedside manner, and thank you for telling me you had multiple myeloma years before and remain disease free. (The only thing that could have made the whole experience better, for the next patient, consider leaving out the part about your PICC line getting infected. :) ) Thank you.There are so many people to thank. Right now I am acknowledging you, MD Anderson. Thank each and every one of you. I am weeping now in gratitude as I get in touch with the magnitude of the gift and how you gave it. Jackson just turned 3. He will thank you one day. For now, I thank you on his behalf.Oh my! There are so many people to thank!To be continued…EDIT: January 7, 2020An interesting “problem” is arising here… the longer I live, the less appropriate the word “recently” in the opening line of this answer is… in December, less than a month ago, I went back to MD Anderson for my first checkup since July. All is well and my MRD continues to be negative over a year after entering remission. Thank you, Dr. Pemmaraju and all of you at MD Anderson.And, as I mentioned above, there are many more to thank. I will address two of you now:To Nortin Hadler, MD, of UNCSOM. Nortin, your startlingly deep compassion and ability to read between the lines of what I was saying moved me to tears. You heard me asking things I didn’t know I was asking. Your clinical acumen and profound compassion were so intense at times it was hard to be with. You encouraged me at a deep level. Not long before I was diagnosed with AML, I wrote you to thank you and tell you how much your work has meant to me as a physician and reader. I didn’t expect a reply, let alone one of such thoughtfulness. Then, during my struggles with leukemia, you shined as a lighthouse of steadfast personal and clinical wisdom. Thank you for hearing what I didn’t even know I was expressing and addressing it.To Steve Derdak, DO. My sister, one of the finest physician’s I know, refers to you as the smartest physician she knows. That’s quite an endorsement. I still remember visiting you when you were in medical school and thumbing through your Harrison’s Principles of Internal Medicine to find it thoroughly highlighted. Years later as an intensivist at Brooke Army Medical Center you brought your vast clinical experience to me personally in a very frightening and challenging time. Thank you for being there. And thank you for your sweet, personal bedside care of Marty at our home during her final days.And thank you Quorans for your views and upvotes. I deeply appreciate it!More to come.Edit: June 21, 2020Went back to MD Anderson a couple weeks ago for a routine followup. Results were all good except MRD.CBC great. Bone marrow aspirate showed 1% blasts (normal is < 5%). All very exciting. 6 days out a notification popped up on my phone that Dr. Pemmaraju wanted a telephone appointment with me.That was not welcome news, and I couldn’t wait until the next day to find out why. I called his PA, Rodney, and learned the news. My Measurable Residual Disease is now positive. I am in morphological remission, but not at the level of resolution provided by amazing technology.Dr. Pemmaraju’s recommendation is 3 rounds of venetoclax and azacitidine (VEN/AZA). Mild chemo… he used the analogy that the previous chemo is like a bomb and the VEN/AZA is like a Predator drone strike.He said my MRD will turn negative again. And he referred me back to the Stem Cell team.No problem seeing the Stem Cell team again for a consult but I was dead set against it.My thinking was why would I sacrifice feeling great for the devastation SCT is?And I’ve already created this narrative of how powerful mind/body medicine can be…It wasn’t an easy choice at all. And at one point in the last 16 days of wrestling with my circumstances I decided to do SCT but from a place of fear. (There’s a powerful distinction between choosing and deciding worth taking a look at.) Then I decided against it.At some point I looked at the scientific research and statistics on it; then I watched some inspirational videos by successful recipients and using the rhetoric from one of those people, switched to viewing SCT as an investment in my future. And I went back to my matrix of 4 cells and considered each possibility it boiled down to which mistake I would rather make…Have a stem cell transplant when I could’ve done well using mind over matter after allorNot have a stem cell transplant when in fact I needed one to prevent death by AML progression?Decision is derived from the root word “cide” or to kill off. In a decision the circumstances and considerations determine the selection… you have a pro list and a con list and the selection is based on which list is longer. The alternative is killed off by the considerations.Choice: To select freely and after consideration.Initially I decided no. Then I decided yes. All of that occurred in a field of fear and suffering.At some point I chose SCT and a feeling of peace came over me.I am at peace with the choice and the outcome.Once again, I think I will fare exceptionally well and I know that isn’t a given.I realize one outcome is death by overwhelming infection, organ failure or graft vs host disease.That is out of my hands. I accept my fate. I choose it.And I am happy to share the journey ahead.Edit: August 3, 2020Day 1 Cycle 2 of venetoclax and azacitidine. Mild chemo. The first cycle of this had few side effects and no hair loss. It was surprisingly hard on my kidneys… the cycle is Monday through Friday every 28 days (if possible) and my creatinine spiked to 1.5 on that Friday. It returned to normal and a nephrology consult concluded it was a reaction to the venetoclax. Dr. P concluded it was an idiosyncratic reaction and doesn’t think it’ll happen again.Edit: November 3, 2020Getting Busulfan at MD Anderson this morning in preparation for a stem cell transplant.I am quite well and continue in morphological remission. My MRD turned positive in June for the first time since December 2018. I’ve accepted MD Anderson’s recommendation for a SCT. It’s been their recommendation all along, but until June insurance wouldn’t pay for it and I didn’t want it. However, confronting a dead canary down here in the mine, two thoughts persuaded me.I have three boys, the youngest is four. In that context I look at this as an investment in the future; and, I’d rather have it and not need it than need it and not have it… I met a wonderful man in his early 70’s, John, in an infusion room last year. Delightful. I got to talk to him at length twice. Delightful man. He looked well to me. However, his chemo had never gotten him into remission and he died very quickly. His death hurt deeply. I grieved his death and I could feel the pain of it much more acutely than my mother’s 8 years ago, something I think odd. Perhaps it was the reminder of my vulnerability.I remain optimistic and grounded in my choice and commitments.Today is the first day the thought, “I am a writer” occurred so consonantly. Perhaps the dawning of the reality of death, not necessarily of its immanence, but of its ultimate reality, shifted my audience from what others think to what I think. I’ve a story to tell. It’s for me and that others may benefit.“The ill person who turns illness into story transforms fate into experience…” —Arthur Frank, from The Wounded StorytellerFootnotes[1] Minimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working Party

Yes.Me.Here is how I answered your question under a Quora question about how often to have labs if you’re healthy:I was very arrogant about my health until recently.At 59, I had never been sick, I’m very fit, and look quite a bit younger than my age. My father is 89 and lives the same lifestyle now as 20 years ago.I’m a physician and have almost daily occasions to offer health advice, and I have a healthy, thriving practice.I am a fan of Nortin Hadler, MD, who writes extensively on intelligent, informed healthcare, offering facts and studies a healthcare consumer should be aware of before giving or refusing consent to commonly recommended medical treatments such as high cholesterol, blood pressure, or glucose; colonoscopy; mammography; PSA screening and more. Lest you think he’s fringy, he’s Professor Emeritus of Medicine at UNC School of Medicine at Chapel Hill, and Harvard and Yale educated. You can see his brilliance and relevance in this PBS interview.For 20 years or so, I’ve seen a wonderful internist, but, would abdicate responsibly for this behavior, saying. “The only reason I have a doctor is I have a wife.”Thank goodness I have a wife.September I had previsit labs for my annual visit with Rick, who was Chief Resident during his residency at Emory. My white count was low. Rick’s nurse called and said he wanted another CBC and a folate. White count low; folate normal.Then, I saw Rick in his office and we chatted dispassionately about the neutropenia… WBC was around 2, with 4–12 being normal.He told me he had talked to a local heme/onc and then, he shrugged his shoulders and said, “Looks like you need to see a hematologist…” I agreed.About a month later, I had extensive labs at the local oncology center; met the delightful hematologist who recommended a bone marrow biopsy.I knew this was coming and, once again, being very healthy and having no signs or symptoms, I thought serial CBC’s would do.However, after my consult, I had no urge to refuse the bone marrow biopsy.Things moved quickly from there.The day after the biopsy, Dr. N called and said I needed to see a specialist at Baylor. Five minutes later, she called back and said, “You could also go to MD Anderson.”Baylor is two hours, MD Anderson is four.Initially, I balked at accepting an MD Anderson referral, as this meant, in my mind, saying, “This is serious.”Over the next 24–48 hours, I had the strong intuition I should go to MD Anderson.I responded to Dr. N’s telephone call about my choice in a way I found funny/odd… I said, “I owe it to my family to go to MD Anderson.” I thought, “Wow, Dude, you can’t even take responsibility for your choice to go to MD Anderson.” (It wasn’t a big deal… but, interesting.)My records and actual marrow specimen were Fedexed to MDA; I went there for labs and another biopsy; and met with a national leader in leukemia.All this occurred in a very compressed period of time and in a context of general surreality, punctuated by briefs periods of extreme surreality.I had accepted there was something wrong with my bone marrow (I had actually been aware I was neutropenic as far back as August 2016… but again, arrogant invincibility had me ignore it. Two other providers were aware of it, but, so was I. No complaint there, now or ever), but I was thinking myelodysplastic syndrome (MDS)… something I was familiar with when a fellow staff psychiatrist told me about it. It was a significant health scare for him, but that was in the 90’s and he and I were in touch for at least 10 years after that, and to my knowledge, he’s fine (we both moved on from that mental heath center years ago).When I was going through the process leading up to seeing my MDA leukemia specialist, a nurse who was checking me in and reviewing my chart, was reading out loud to herself… as I listened, it was all quite routine to me as a health care provider, until the letters “AML” came out of her mouth.They weren’t intended for me; she was just one of those people who reads out loud when they read. Perhaps she thought I knew. Perhaps she didn’t know she was reading out loud. It is a cancer center…I didn’t allow my body posture or facial expression to change; however, the biggest WTF! rang out in my mind…“It’s leukemia?! I have leukemia?!!!” My mind was reeling with that shock…It was quite a mental shift (in an instant… unsuspecting… unprepared…) from MDS to AML.I suppose it was helpful to be past that initial reaction later, as I sat, waiting to meet Dr. P, who burst into the exam room almost as enthusiastically as Kramer on Seinfeld. He was young, energetic, positive and extremely enthusiastic.There I was, sitting face to face with one of the finest allopathic physicians there is… a hematologist/oncologist who only treats two types of leukemia and MDS.It was a briefly challenging/confronting situation on a philosophical level.You see, I’ve been writing, Power Without Pills: A Curious Psychiatrist’s Guide to Healing and Growth in the Modern World since Googling John Sarno, MD in February 2006. And, I have talked some trash about modern medicine. Not irresponsibly or inappropriately… but, trash talking nonetheless.I was challenged with substantial, in-my-face, cognitive dissonance.I resolved it for myself quickly.I had been throwing the baby out with the bath water.I had been all “mindbody medicine is where it’s at!” and, then and there, I realized I had been going to an extreme.I once heard a man say, “You’re just as half-assed no matter which cheek you got.”So, I decided, “Alright... I like this guy... I trust this guy... I’m going to roll with this, and I’ll handle the mindbody part... and he’ll handle the traditional medicine part…”Both cheeks were suddenly firmly in place.He told me they have a clinical trial where they’re getting upwards of 90% complete remission rates in frontline AML.All three drugs are FDA-approved for AML, but no one is using all three together. “We are gonna rock this thing! We are going to crush it together!”, he said, beaming.He told me I’d need some preliminary tests, like an echocardiogram, to qualify for the study... a formality.Then, I would be admitted, given five days of chemo, be in isolation, and have a total of around 28 days inpatient before being discharged to outpatient treatment where I would receive five consolidation rounds of the same three chemotherapy drugs every 28 days.He said I’d be in complete remission by Day 28.That conversation was on the Friday before Thanksgiving. He told me to go home and spend time with family... my wife was there in that initial consult and throughout, but I hadn’t seen my father in Austin in a while... it was a wonderful, deeply meaningful break/visit with close family before I went inpatient… ostensibly 28 days, in isolation.On the Wednesday before Thanksgiving Day, I was admitted to the Leukemia Specialty Care Unit at MDA, at around 7 pm, and began chemotherapy that night.It went exactly as he said; except I had a Day 21 bone marrow biopsy in the hospital. The next day, the attending on the service came briskly into my room, smiling, and said, “Go home. You don’t need to be here any more.”My blast count had gone from the 30–40% range to 4%, complete remission, in 21 days.I said, “Uh… I’m not ready.” (My wife was four hours away and expecting me to be discharged in about a week).I went home the next day, six days early, for good biological behavior.I was in complete remission.There was suspense though. I was told through some magic called flow cytometry, they could give a measure of prognostication, MRD, Measurable Residual Disease. With MRD, they could find traces of leukemia at the subcellularlevel.On my first outpatient follow up, I was given the news, “You are MRD negative.”The Senior Coordinator of Clinical Studies, Department of Leukemia, MD Anderson Cancer Center gave me that wonderful news, and added, “I have never seen an MRD negative patient at Day 21.”It was one of many profound blessings in this powerful life lesson leukemia brought to me.The leukemia was caught on a yearly routine blood test before I was symptomatic.I am young and healthy, with no comorbid illnesses, and I really stood out on the Leukemia Specialty Care Unit because of my youth, fitness, and lack of comorbid illness.I got the best cancer treatment in the world, I assert.I’ve had an excellent attitude throughout.I never fought the leukemia. I was never inclined to. At the local cancer center, the narrative was everywhere about fighting cancer; even the wifi password had that rhetoric… yet, I could not abide by that narrative.I’m not suggesting that people not adopt that narrative; it’s fine with me if they do; it’s just not for me. I’m not going to start a “Fight Fighting Cancer!” campaign. I do want people to know there’s more than one narrative to adopt in the face of cancer. Pick according to your gut.I’ve said thousands of times: “What you resist persists.” I would not fight. I would listen.I viewed the leukemia as a messenger, and my job was/is to get the message.I have enjoyed Louise Hay’s work, and was aware of the fact she gave meaning to particular illnesses.I thought, “Leukemia is a childhood disease…”I had started guided journaling at What is Self Authoring? many months earlier, and had started with the Past module (there are also two for the present and one for the future… starting with the past made the most sense to me…) but, I quickly fell into procrastination…One obvious message was, “I wouldn’t do that if I were you…”, meaning, I got one message as, “Don’t put off that work.”Now, acute myeloid leukemia is relatively rare with about 20,000 newly diagnosed cases a year. That’s an incidence of 0.006%. It’s rare.But, things would likely be much darker (which sounds weird to write, because I can’t say they’re dark (though I can admit if one looks at the five year survival rate for AML, one would be inclined to say they’re dark… but, that’s a statistic, and part of good mindbody medicine is not being negatively influenced by stats…)) if I hadn’t been getting yearly routine labs.TLDR:Get yearly routine labs like a CBC and complete metabolic panel.The risk/benefit ratio argues for it.Think of it as insurance… you definitely want to have it, even though you don’t want to use it.Extra credit edit:So as to exclude as few readers as possible, I am adding an important point…I have used the word, “blessing” more than once, and said that there is meaning in this life challenge/lesson, thereby asserting/strongly implying it’s not random; we don’t live in a strictly mechanical Universe, in which we humans are machines that break and consequently go to doctors that intervene on our behalf and restore us to health.I believed that worldview until the age of 23. I no longer believe that… but no matter…I’m working on a reply to the gentleman’s comment in which it’s asked what I think caused the leukemia.My reply involves logic I learned from my mother, an adept at logic. She changed her worldview late in life with logic.She told me one day, she had done a thought experiment in which she made a matrix of cells… the particulars will be in the reply when I post it.It is the particular thought exercise that’s relevant here:Let’s say you can’t abide by the notion of an actual blessing, or the idea there’s meaning to be mined in a disease, especially a life-threatening one like leukemia, you can still potentially get the value of that system/belief through this exercise:Let’s construct a matrix of four cells: 2 rows, 2 columns…I’m blessed really/I’m not actually blessedI believe I’m blessed/I reject the possibilityThen stand in each cell and look out at the world as if those conditions are so… what do you see? Is that possibility empowering?You see, it isn’t the truth that I was blessed and it isn’t the truth there is meaning, not randomness, in the leukemia… it’s a powerful place to stand.For the strictly “If I can’t see it in a lab, it doesn’t exist,” Do you want to be empowered, or do you want to be right?