Lesson 3 16 A Story Of Units Lesson 3 Objective: Use The Place Value Chart To Record: Fill & Download for Free

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

In comparing norms in the East and the West, generalizations are required since we are speaking about over a billion individuals. To simplify my answer I focused on comparing the United States to India.In the West, we don’t like to kick people when they are down. A lot of people stick up for an underdog and may step forward to give them aid and comfort when this happens. A strong undercurrent (value) in the United States of protecting women and children has been prominent historically in our society although it provided more protection to Caucasian women than to minority women.Systemic psychological beatings and physically beating people when they are going through the worst time of their life has become uncommon in the Western countries. We understand that the vast majority of people who divorce feel bad about what is happening in their lives and we choose to support them—not vilify them.Divorce used to be taboo in the United States. Now that we know keeping people in marriages through societal pressure is unhealthy for individuals and society, divorce is often seen as the best solution to a problem. In the United States of the past, as it is elsewhere in the world today, taboo’s against divorce have a strong negative impact on the quality of life of the women living in the society.When divorce was taboo in the West, individuals stayed in marriages with abusive and addicted partners because of societal and religious pressures that often led to their deaths. It certainly prevented them from living productive lives since living with an abuser doesn’t leave anyone much energy or freedom to do anything other than survive.Source: I created the chart using data from the FBI Before someone points to a gun culture as the cause of intimate partner violence you need to know that strangulation and stabbings account for a high percentage of the murders reflected in these two charts. There are many ways to kill someone who lives with you. I noticed a change of attitude toward divorce after the release of the movie, The Burning Bed in 1984.[1]I have a friend who didn’t believe in divorce because of her religion. She was married to an alcoholic abuser. He worked the oil rigs off the Louisiana shore so he was gone several weeks at a time and would then return, drink and beat her. He didn’t care if their children saw him beating her. He would also go out and have sex with sex workers and get DUI’s. In any other state, he would have long since lost his driver’s license.His legal bills for driving under the influence kept them in poverty despite the good money he made on the rigs and her working full-time while raising the children on her own because he was on the rigs.People trapped in relationships by circumstances, mental beliefs that they cannot leave, and by societal or religious beliefs can end up dead or become murderers.Source: I created the chart using data from the FBI My friend finally left her husband, but most of the damage had been done. She was middle aged without two cents to rub together. A few short years later, when her sons were bigger than she was despite still being young teenagers, her eldest went to strike her when he didn’t like her rules. It is common for the children of abusers to become abusers. You cannot stop the cycle-of-violence by staying in the home with the abuser.Society suffers in many ways when people live in abusive homes. Obviously, the lack of productivity from those who were abused is one way. I’m not saying abused people don’t work—they do. My friends’ career took off after she finally left her abusive husband. It began stagnating when her fear that one of her sons would beat, or kill her, grew. My friend was a loving mom who was fiercely proud of her sons when I met her. But they had learned by watching their father beat and strangle her that it was okay to beat women.Current abuse victims are rarely the ones who excel. They are often the ones who get fired for absenteeism because they can’t come to work after a severe beating, or they have to take care of a child held home from school because of a severe beating. The connection is obvious once you toss the taboo of divorce out the of the room. Former abuse victims experiencing post-traumatic growth can and often do excel.We are also aware of the research about the harm abusive relationships do to the spouse and children living in the abusive home.Children raised in abusive homes, regardless of whether or not they are abused, suffer. Their outcomes are worse in every area of life including physical health, mental health, emotional health, behavioral health, and environmental health. (See Sources)Someone who has been abused has a 1500% higher (15 to 1) risk of being a victim of violence or rape from outside the family.[2] I wrote about this phenomenon in an article last year. I wrote about research that looks at the outcomes of children from abusive homes and that psychological abuse (verbal) leads to the worst outcomes in one of my books.[3]So far, I’ve focused on physical violence but psychological abuse is as damaging. Psychological abuse can be worse than physical abuse because it is easier to heal a broken bone than a broken spirit. Psychological abuse can also be deadly. It leads to dysfunctional and maladaptive coping strategies that include addictions and suicide.Whether a spouse physically kills their spouse, or drives them to commit suicide, it is a form of murder.Let’s look at the East, where women do not have equality. I quote extensively from Violence Against Women in India: Origins, Perpetuation and Reform, Emma Livne’s Capstone paper at Carnegie Mellon University.The distinct rigidity of modern patriarchy “assigns females to a position distinctly subordinate to males: constrained, dependent, exploited oppressed, physically and psychically endangered” (Miller 1993: 366). The idea of purity in relation to gender has been normalized in the Indian populace, and the marginalized societal roles of women follow suit.[4]From the same paper,“. . . the country’s societal structure is top-down, and that those who are lesser in the hierarchy, such as women, are expectant of their unequal rights.”[5]When women accept an unequal position in society they do not demand to be freed of a marriage even when the relationship serves them not. The “devil they know” often leads to less fear than “the devil they don’t know.” This is especially true in a society that condemns divorce.Our minds will adjust to many different norms because we perceive reality. There is not a single reality that is the same as what everyone else experiences. If someone believes their rightful place is subordinate, they will interpret life as if that is the truth. This leads to different thoughts, words, and behaviors. This is adaptive because someone forced (or born) into a situation where they do not have autonomy can survive the lack of freedom better because their perception of it is less stressful than it would be to someone who understands they deserve autonomy and becomes restrained.The paper reflects this when it says, “are expectant of their unequal rights.”Often the most commonly referenced cause of violence against women, the patriarchy can be defined as a social system in which men are placed above women. This being so, group mentality and social practices follow suit, often resulting in the oppression and exploitation of women (Sharma 2014). As outlined in the section on the origins of violence against women, India maintains a strong cultural expectation of women to be chaste and obedient. The normalization of this expectation manifests into women’s acceptance of their prescribed gender roles. This is not to say that women approve of nor appreciate their subjugation, but rather they are socialized to tolerate and even rationalize it.[6] [Emphasis added.]“. . . domestic violence been acknowledged worldwide as a violation of basic human rights, but an increasing amount of research highlights the health burdens, intergenerational effects, and demo-graphic consequences of such violence (United Nations, 1997; Heise et al., 1999; Jewkes, 2002; Campbell, 2002; Kishor and Johnson, 2004; 2006).”In “India, women are socialized to accept, tolerate, and even rationalize domestic violence and to remain silent about such experiences. Violence of any kind has a detrimental impact on the economy of a country through increased disability, medical costs, and loss of labour hours; however, because women bear the brunt of domestic violence, they disproportionately bear the health and psychological burdens as well. Victims of domestic violence are abused inside what should be the most secure environment—their own homes—and usually by the persons they trust most.”[7]From the perspective of my experiences and my Western values, this was a very difficult answer to write. I find reportedly common practices in India unconscionable. Most Western women would not tolerate the type of treatment women in India have been socialized to expect from their mates and families. This chart shows the attitudes of women who believe their husbands are justified in hitting or beating them.Source: I created the chart using data from the NFHS-3 Notice that just the suspicion of infidelity—not infidelity itself —is considered a justified reason for being beat. Note that this isn’t old data from the Middle Ages. This is from the 21st century.It is common for women in India to experience violence at the hands of spouses and family members.Source: I created the chart using data from the NFHS-3 If women in India were free to leave abusive marriages, they would. The current efforts to increase the safety of women in India fall short of the ideal because they do not increase autonomy or increase female empowerment.“. . . safety is most often referenced in relation to women taking measures to protect themselves through remaining inside the house, dressing conservatively and traveling with male escorts.”[8]The devaluation of women is a cultural norm in India.[9]Sons are preferred over daughters.Sex selective abortions of females leads to nearly 100% of abortions “at clinics and women’s centers in Mumbai involved female fetuses.(Sharma, 2014)[10]The dowry system reinforces oppression and violence against women.This increases the perception that girls create a future financial burden.The National Crime Records Bureau of India recorded 8,618 female murders related to dowry conflicts in 2011.The Asian Women’s Human Rights Council estimates a horrifying 25,000 women between the ages of 15 and 24 are killed or harmed by dowry disputes.Despite a law against it, “dowry continues to be a deeply-rooted religious practice.Dowry has additionally become method of displaying social status through wealth.In a hierarchical society such as India’s, the pursuit of a higher social status or economic class is prevalent, creating an environment conducive to dowry.Unsatisfied dowry demands continue to fuel the harassment, abuse and often lethal violence against women.Women do not have economic independence, nor do they have the freedom to pursue employment in many situations.Due to the fact that divorce has a social stigma in Indian society, wives are more likely to remain in their marriage, and tolerate abuse.[11]Lower economic status increases the risk of violence to women and decreases the likelihood that they have any education. Thus, they are trapped by stigma, custom, and an appalling lack of options. The more financial strain the family experiences, the higher the likelihood that the woman is experiencing violence in her home.Source: I created the chart using data from Chartoff, 2015 According to the 2005-2006 National Family Health Survey, a significant proportion of the Indian population is reported to have received little to no form of education. Studies identify one of the “roots” of the issue of violence against women to be education, or a lack there of. Lower education and literacy rates for women lead to a reluctance to seek help, decreased awareness of their rights and laws, and a dependency on male family members.[12]Increased education improves misogynistic and paternalistic attitudes, but does not bring them anywhere near the support women in the West receive from society.Source: I created the chart using data from the NFHS-3 and Chartoff, 2015 Mukesh Singh, a rapist convicted for his part in the 2012 Delhi rape case that garnered international attention was quoted as saying:“a girl is far more responsible for rape than a boy.”, and that “A decent girl won’t roam around at 9 o’clock at night”. Consequently, he explains that he and the other men “had a right to teach them a lesson” (Park 2015).”For readers who are not familiar with this case, the girl who was raped and murdered was accompanied by a male companion and fell for the gang rapists’ ruse of showing up at a bus stop where they thought they were boarding public transport but, instead, boarded a private van where her male escort was rendered unconscious and she was brutally raped by multiple men and with implements that led to her death almost two weeks later.Here, we can look at the beliefs that were held by rapists that they have a right to teach a woman a lesson. In a society where those types of beliefs are held, it is safer for a woman to be in an abusive marriage than to attempt to survive on her own.Contrast that with the United States, where women are free to obtain an education and to pursue higher education. Women in the United States are also free to carry a gun in most states. If Jyoti Singh had been armed, her story would have ended very differently. Just the thought that she or her companion might not be defenseless might have been enough to thwart the rapists idea that they could trick them into the van and treat them the way they were treated.Women in the United States are not prisoners in their homes because they have the ability to be financially independent and the ability to protect themselves.The student who wrote the paper I’ve cited heavily reported that she lived in northern India while studying Hindi and Public Health. During that time she reports:[13]I was consistently fully covered in conservative, traditional clothes even in the sweltering summer.My home-stay parents required me to constantly update them on my whereabouts, and to return home by 9pm every night.I was instructed never to make direct eye contact with or smile in the direction of men in passing.I was consistently met with intruding, appalled stares from groups of men when I was alone.I was aware of the lack of freedom and dignity provided to women in India.When women are not free to live unmolested and women are not free to pursue an education and career, they stay in marriages because a bad marriage is better than death or starvation. Most marriages in India are still arranged so the woman who leaves her husband is not just leaving her husband, she is leaving the man her family expects her to be with and that is often seen as going against her parents.In the West, most parents would encourage or, at the very least, support a woman or a man who wants to leave an abusive spouse. They want their children to be happy and safe more than they care about what the neighbors, village elders, or religious leaders think about the decision.Honor killings in some parts of India teach women and men that love is not a priority in marriage.[14] , [15]India didn’t begin tracking the rate of honor killings separate from murders until 2014.[16] It is believed that honor killings are still woefully under reported, especially in villages where everyone believes the family is shamed when a couple falls in love, especially if the parties involved are from different castes or otherwise considered inappropriate.Caste supremacists that seek to segregate people by artificial lines, much as was done in the racist history of the United States where anti-miscegenation laws were once the law of the land.The lower divorce rate in India does not reflect a healthier society or better marriages. It reflects a prison that incarcerates many women in horrendous violent homes with no visible means of escape.There are some who argue that cultural norms should be left alone and that they are sacrosanct because we should preserve culture. Tolerating human rights violations because they are cultural norms is a repugnant way of living—where ever those cultural norms exist. Culture is not more important than the individual right to be safe and free from harm—especially in one’s home. I recognize that this probably reflects a Western value. I can only perceive the world through the lens of my own experiences and beliefs. I will say that science supports my stance about the harm to individuals and to societies that is perpetuated by tolerating abusive homes.A nation with the rate of violence against women reflected in the studies I reviewed while writing this post cannot and will not thrive as long as this situation is a mainstay of their culture. They are handicapping themselves.Chronic stress is near the root of all physical and mental health illnesses and responsible for the failure to thrive in every area of life.[17] , [18] ,[19] The effect of chronic stress is reflected in every faucet of life in India including the lower life expectancy and poverty.Source: (c) Jeanine Joy, 2018 based on data in cited answer[20]In India, making divorce a taboo is one arrow of many ways to keep women subjugated and trapped in situations they would leave if they were able to do so as free, educated women.When I began writing this answer, I knew very little of the situation in India. I knew people in Western cultures are free to choose their spouse and that in India the family often chooses the spouse over the objections of the people who will be in the marriage.[21], [22] ,[23] ,[24] , [25] It is a complex issue and I am far from an expert on the culture in India. I referred to reputable research sources in order to answer this question but I did not do an exhaustive search. While I didn’t eliminate any source that I found, I also did not make an effort to identify all reputable sources of information. Since I have no intention of writing a dissertation on this subject and despite an urge to get on a plane and go to the aid of these abused women, it doesn’t feel safe to do that.Until it is safer for women to speak up, it is men who will have to step-up and come to the aid of women in India. Preferably this will happen from inside the country.I know some individuals from India socially. The ones I know place high value on science. I urge India to consider what the research says about the negative effects of living and being raised in abusive environments and use that as the basis to begin changing cultural norms that facilitate and support the abuse of women. If that leads to higher divorce rates, so be it. If men are taught stress management skills, they could reduce the likelihood of committing violent acts against women. It is clear that stress increases violence against women.I know there are dozens of nuances, if not hundreds, that are not reflected in my answer. This answer views the situation through one of many possible lenses.Remember the caveat at the beginning of this answer that reminds the reader that generalizations encompassing over a billion individuals can only reflect norms; not individual circumstances. I’m sure there are individuals in India who are happily married just as I know that there are women in the United States who remain in abusive relationships.Sources:Beijer, U., Scheffel Birath, C., DeMartinis, V., A.F. Klinteberg, B. (2015). Facets of Male Violence Against Women With Substance Abuse Problems: Women With a Residence and Homeless Women. Journal of Interpersonal Violence; Dec 4. DOI: 0886260515618211.Centers for Disease Control and Prevention. (2015). Intimate Partner Violence: Consequences.Defense and Veterans Brain Injury Center. (2016). Recognize TBI and ConcussionDelara, M. (2016). Mental Health Consequences and Risk Factors of Physical Intimate Partner Violence Mental Health in Family Medicine; 12: 119-125.Goodman, L.A., Fels, K., Glenn, C., Benitez, J. (2011). No Safe Place: Sexual Assault in the Lives of Homeless Women National Resource Center on Domestic Violence.Health effects of violenceJina, R., Thomas, L.S. (2013). Health consequences of sexual violence against women. Best Practice and Research: Clinical Obstetrics and Gynaecology; 27: 15-26.Modi, M.N., Palmer, S., Armstrong, A. (2014). The Role of Violence Against Women Act in Addressing Intimate Partner Violence: A Public Health Issue. Journal of Women’s Health; 23(3): 253-259.National Alliance to End Sexual Violence. (2011). The Costs and Consequences of Sexual Violence and Cost-Effective SolutionsPetrosky, E., Blair, J.M., Betz, C.J., Fowler, K.A., Jack, S.P.D., Lyons, B.H. (2017). Racial and Ethnic Differences in Homicides of Adult Women and the Role of Intimate Partner Violence – United States, 2003-2014. MMWR; 66: 741-746.Smith, S.G., Chen, J., Basile, K.C., Gilbert, L.K., Merrick, M.T., Patel, N., et al. (2017). The National Intimate Partner and Sexual Violence Survey: 2010-2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.Footnotes[1] The Burning Bed - Wikipedia[2] http://Volpe, J.S., “Effects of Domestic Violence on Children and Adolescents: An Overview”, The American Academy of Experts in Traumatic Stress, 1996.[3] Rescue Our Children from The War Zone: Teach Social and Emotional Skills to Improve Their Lives: Applied Positive Psychology 2.1: Jeanine Joy Ph.D.: 9781535424400: Amazon.com: Books[4] https://www.cmu.edu/dietrich/globalstudies/images/docs/livne-gs-capstone-paper.pdf[5] https://www.cmu.edu/dietrich/globalstudies/images/docs/livne-gs-capstone-paper.pdf[6] https://www.cmu.edu/dietrich/globalstudies/images/docs/livne-gs-capstone-paper.pdf[7] https://dhsprogram.com/pubs/pdf/FRIND3/FRIND3-Vol1[Oct-17-2008].pdf[8] https://www.cmu.edu/dietrich/globalstudies/images/docs/livne-gs-capstone-paper.pdf[9] https://www.cmu.edu/dietrich/globalstudies/images/docs/livne-gs-capstone-paper.pdf[10] https://www.cmu.edu/dietrich/globalstudies/images/docs/livne-gs-capstone-paper.pdf[11] https://www.cmu.edu/dietrich/globalstudies/images/docs/livne-gs-capstone-paper.pdf[12] https://www.cmu.edu/dietrich/globalstudies/images/docs/livne-gs-capstone-paper.pdf[13] https://www.cmu.edu/dietrich/globalstudies/images/docs/livne-gs-capstone-paper.pdf[14] India 'honour killings': Paying the price for falling in love[15] Six men sentenced to death in India for Dalit 'honour' killing[16] Honour killings in India 'soar by nearly 800 per cent'[17] Jeanine Joy's answer to Should I put my mental health first?[18] Jeanine Joy's answer to How important is mental health in public health context?[19] Jeanine Joy's answer to What are the signs that stress from anxiety disorder has damaged your body?[20] Jeanine Joy's answer to Do limiting beliefs and/or a poverty mindset prevent people from wealth creation?[21] I am Indian. I have loved my boyfriend for 8 years. We are in good careers, and want to marry, but my parents don't approve. He is a different caste. They will not attend my wedding and will break all ties with me going forward. What should I do?[22] How do I convince my parents to let me marry a guy who I love? My boyfriend and I are from different states and castes. We love each other and want to marry. He has been my best friend for the last 6 years.[23] How should I convince my parents for an intercaste marriage?[24] How can a women stay single forever in India and be safe as well?[25] Do arranged marriages in India really work? Do people avoid divorce simply because it’s taboo? Why is the divorce rate so much lower?

The Best Movies Trilogies Of All Time.15. THE MATRIXKeanu Reeves in The Matrix Revolutions The Best Movie Trilogies Of All TimeThe Matrix took movie screens by storm in 1999 and redefined modern cinema overnight. Using its own filmmaking language and techniques, its virtual world showed us so many things we’d never seen before (many of them based on anime‘s tendency to defy the laws of physics) while wrapped around a story filled with heady philosophical ideas and astounding action sequences. It didn’t hurt that it reframed the perennial “Hero’s Journey” — the same basic story structure used by Star Wars and countless others — as something fresh, smart, and stunning to behold.Its sequels were another case of the “couldn’t live up to the original” problem that plagues so many franchises, though it’s hard to pinpoint exactly what went wrong. It certainly wasn’t the ideas department, as the Wachowskis brought a truckload of fascinating new ones to the table. The production design, visual effects, and overall ambition took gigantic leaps forward, while intriguing new characters were added to the already appealing cast.But something fell apart somewhere in the presentation. A precisely-defined endpoint was set forth in the original: Morpheus (Laurence Fishburne) told Neo (Keanu Reeves) that “as long as the Matrix exists, mankind will never be free.” In other words, it was Neo’s destiny to destroy the Matrix and free all the humans trapped inside. The sequels — the stylish-but-bloated The Matrix Reloaded and the dour, unsatisfying The Matrix Revolutions (both released in 2003) — ignored this mandate entirely, instead deciding that saving the Matrix was preferable. As long as über-powerful Agent Smith (Hugo Weaving) was ejected from the system, Neo and the gang would settle for peaceful coexistence with the machines (as long as humans still in the Matrix could opt-out of it, or… something). Because nothing could possibly go wrong with that.The change was undoubtedly so that Warner Bros. didn’t have to close the door forever on one of its most profitable franchises. (For years, rumors have circulated that more Matrix movies are being considered.) Yet if “everything that has a beginning has an end,” as The Matrix Revolutions told us, it’s a crying shame — not to mention confusing — that this trilogy was robbed of its proper conclusion. Nevertheless, the transformative experience of The Matrix makes this an unmissable slice of pop culture history.14. IRON MANRobert Downey Jr. in Marvels Iron Man The Best Movie Trilogies Of All TimeWhat can be said about the first Iron Man that hasn’t already been stated many times over? It launched both Marvel Studios and the connected “Marvel Cinematic Universe.” It jumpstarted Robert Downey Jr.’s career, elevating him to the highest-paid actor in Hollywood. The movie benefited strongly from the catharsis of seeing Downey overcome his own history and settle into a high-profile role that was the perfect showcase for his comedic and dramatic skills. The cast created most of its own dialogue in that first movie, which added to its realism and sharp humor, while director Jon Favreau staged several stand-up-and-cheer action scenes that audiences couldn’t get enough of.Iron Man 2 stumbled after being rushed into production after the first movie’s box office success, jamming in far too much story for a single film. The over-complicated plot throws a number of obstacles in Tony Stark’s path: an enemy with a personal vendetta against the Stark family, a business rival who wants to take Tony down, the U.S. government wanting to acquire the Iron Man technology for its own uses, and the slow poisoning of Tony’s body by the arc reactor that’s made him a superstar. It also tries hard to work in a romantic subplot with Gwyneth Paltrow’s Pepper Potts, even though that bit feels tacked-on. But hey, it also gives us that cool suitcase armor, and introduces Scarlett Johansson’s Black Widow in a flashy fight scene.Iron Man 3 picked up the story strands of The Avengers while bringing in director Shane Black to craft a grittier story about yet another figure from Tony’s checkered past who returns to haunt him. The tone and presentation of the film is drastically different than what came before, digging deeper into Tony Stark’s soul and finally letting him find peace in both his personal and superhero lives. It also featured a truckload of thirty-some Iron Man suits, all of which show up for the finale.Although this trilogy has been overshadowed by other Marvel films, Iron Man’s golden face plate remains the icon that defines the entire enterprise. Robert Downey Jr., meanwhile, continues to change and grow his portrayal of Tony Stark; his recent turn in Captain America: Civil War may have been his best yet.13. SPIDER-MANTobey Maguire as Peter Parker in Spider Man 2 The Best Movie Trilogies Of All TimePeter Parker is Marvel Comics’ most popular character, a hero with enduring appeal who’s been around almost as long as DC rivals like Superman and Batman. Encouraged by Bryan Singer’s success with the X-Men movies, Sony decided to revive its long-dormant film rights to Spider-Man. This was a character who’d never been given his proper due, after all, having suffered through a cheesy live-action TV show, and a handful of cartoons that ranged from halfway decent to downright goofy. Getting to see a proper translation of Marvel’s wall-crawling hero with modern effects and filming techniques sounded brilliant.For years, it looked like James Cameron was going to take on his first superhero flick, but those plans fell apart. When Sam Raimi was handed the reigns to create a big-budget Spider-Man movie for Sony, Marvel fans were a little skeptical. Viewers of the Evil Dead movies, however, were wholeheartedly on board, knowing exactly what Raimi was capable of. The director surprised everyone by casting indie darling Tobey Maguire, who showed off an astonishingly buff physique at the movie’s first press conference. Fans’ fears were fully erased when the trailers arrived, showing off an exciting blend of strong storytelling, colorful comic-like production values, and dynamic, fast-paced visuals that brought Peter’s spider-powers into the real world.Spider-Man swung into theaters in 2002, solidifying a new age of superhero films that has only increased in dominance since. Raimi gave us a near-perfect depiction of the classic story of the everyman who gains extraordinary powers, and Maguire proved himself perfectly cast as the good-hearted hero who’s forced to learn harsh lessons. Spider-Man 2 ignored the Batman formula of focusing on the bad guys, instead furthering the growth and change of Peter Parker as he matured into his role as Spider-Man. Sure, it was a bit heavy-handed in continually beating down a down-on-his-luck Peter, but the story — about confidence, purpose, and selfless love — was electrifying, and Alfred Molena gave us a fleshed-out villain in Doc Ock. It bested the first movie in every way.Spider-Man 3 succumbed to the Curse of the Third Film, as Raimi acquiesced to studio and fan pressure to include fan-favorite villain Venom, while the director himself preferred classic baddie Sandman. It also featured an unwelcome retcon regarding Uncle Ben’s murderer, and dangled before us a “happily ever after” for Peter and MJ before tossing that whole-hog out the window. Going back to the “MJ’s been captured” well for a third time for its final fight only made it seem like Raimi was running out of ideas. Add in the culmination of Harry Osborn’s story, and it’s obvious that Spider-Man 3 tried to do way too much.A fourth movie was planned but abandoned when Sam Raimi and the studio wanted different things. Andrew Garfield eagerly stepped into the tights for a pair of rebooted films, but despite a fine showing from him, the second movie was a muddled mess. Sony eventually caved to Marvel’s superiority in the superhero genre by allowing Marvel to produce a new series of Spidey flicks starring Tom Holland — who exists in the Marvel Cinematic Universe.12. EVIL DEADBruce Campbell as Ash Williams in The Evil Dead II The Best Movie Trilogies Of All TimeWhen childhood friends Sam Raimi and Bruce Campbell decided to make a movie, they had no idea what they were getting themselves into. With Raimi writing and directing, Campbell starring, a location shoot at an abandoned cabin in the Tennessee forest, and a meager budget, on came the rise of The Evil Dead. It’s considered among the greatest horror films of all time, because it broke the horror mold by melding it with comedic elements. It had so many horror tropes — a cabin in the woods, an Indian burial ground, incantations from a mystical book, co-stars that turn evil, a hero that barely survives — but it remixed them with witty one-liners and slapstick physical humor. One rave review later (from a certain horror writer in Maine) and there was a phenomenon at the cineplex worth talking about and taking your friends to.Evil Dead II picks up immediately where the first movie left off, finding Campbell’s Ash Williams unable to escape the cabin where he’s just lost all of his friends. Although the movie retreads much of the same ground as the first, it does so with a larger budget and far more confidence. It’s in this episode that Ash is forced to cut off his own hand (it becomes possessed) — a twist that ultimately leads to his adoption of the iconic “chainsaw hand.”The final entry abandons the naming convention used thus far, going with Army of Darkness. It picks up Ash’s story after he’s been sucked through a portal and deposited in medieval times, where he leads an entire kingdom against an invasion of the dead. Some of the darker edge is lost in this one, but the snark is dialed up to eleven, as is the scale.Campbell practically invented the “cocky hero” archetype, swaggering his way through the series and into the heart of pop culture itself. Raimi would find this platform a perfect launchpad into a successful, diverse film career. Campbell would return as Ash Williams 22 years later in the TV show Ash vs. Evil Dead on the Starz network.11. THE BEFORE TRILOGYJulie Delpy and Ethan Hawke in Before Sunrise The Best Movie Trilogies Of All TimeNo heroes. No villains. No explosions or enormous stakes. Before Sunrise is a quiet little movie about a chance encounter between two lost souls that leads to an unlikely romance. Unapologetically tender, subtly sexy, yet never descending into sap, it reeled in audiences with an irresistible pair of travelers who agree to wander Vienna all night, talking and exploring the city, while waiting for their respective journeys to continue in the morning. Ethan Hawke and Julie Delpy demonstrate unquestionable on-screen chemistry, while flirting and revealing the deepest secrets they hold — because they can’t tell them to friends and loved ones. Over the course of a single night, these two strangers come to know one another in the most intimate of ways… And then part company.Before Sunset revisits them nine years later, when Celine (Delpy) finds Jesse (Hawke) at a Parisian bookstore, where he’s signing his own bestseller for customers. Jesse has to get to the airport after the signing, but he has an hour to spend with Celine, during which they delve into even more personal topics. This time, they decide to act on their feelings and wind up together.Before Midnight has a completely different tone, picking up another nine years on, this time with our couple now married (with twin daughters), but feeling romance slipping away in the mundane of day-to-day life. Given how much audiences have invested in these two by this point, you can imagine how it ends. But that’s not really the point.What the “Before” trilogy did was show us that great cinema doesn’t have to be filled with wall-to-wall plot. This humble trio of “movies about people talking,” often in long, single takes, was every bit as absorbing as the greatest moments that film has ever recorded. Also setting this trilogy apart is the fact that its two stars wrote or rewrote most of the dialogue from all three movies, which is at least part of the reason the movie feels so natural and real. Writer/director Richard Linklater has given the theater plenty of great movies, but the Before trilogy stands alone as an exquisite work of art.10. MAD MAXMel Gibson in Mad Max 2 The Road Warrior The Best Movie Trilogies Of All TimeBefore Katniss Everdeen, Caesar the ape, or Neo, before even Sarah Connor or Snake Plissken, and long before post-apocalyptic dystopian drama was all the rage… George Miller gave us Max.In 1979, Mad Max introduced cinephiles to Max Rockatansky (Mel Gibson, in his first major role), an ex-cop and a wanderer across the wastelands of Australia after society has collapsed and resources become dangerously scarce. He’s a skilled driver and an adept warrior who can’t seem to stop helping others despite his desire to be alone after his wife and son are murdered. The first film is essentially a revenge thriller wrapped in action movie trappings, but Miller somehow manages to turn the dry, dull landscape of the Australia desert into a gripping, stylish backdrop for life after the end of the world.Two years later, Max returned in The Road Warrior, which added a mythological aspect to the character. The story is propelled by Max’s need to procure coveted gas to power his signature hotrod, but eventually it brings him into the orbit of a group of survivors trying to defend themselves against a wicked gang led by “Lord Humungus.” You can guess what happens next.The franchise took four years off before returning for Gibson’s final (and what Miller thought would be his final) entry, Mad Max Beyond Thunderdome. A bigger, more expansive film, this one incorporates the familiar theme of survival-vs.-morality as Max goes up against an anti-villain played by Tina Turner (sporting what may be the most extreme shoulder pads of all time) to save another colony of refugees and help them find a new home.Defined by bizarre characters with goofy names, over-the-top action set pieces, and a reluctant hero always forced to make difficult choices, the Mad Max franchise maintained a high standard of quality throughout its run. Thirty years after Thunderdome, George Miller triumphantly revived the franchise with the universally-adored Mad Max: Fury Road. Tom Hardy took over the titular role (he’s contracted for up to four more, should Miller choose to go that far), and Miller dove back into Max’s world with a renewed vigor and sense of purpose. He’s currently at work on the next film in the series.9. THE “THREE COLORS” TRILOGYIrene Jacob and Jean Louis Trintignant in Red The Best Movie Trilogies Of All TimeDon’t feel bad if you’ve never heard of this one. It’s an art house trilogy by one of the most acclaimed European directors of all time — who you also may have never heard of. Krzysztof Kieslowski constructed this intricate house of cards, released in 1993 and 1994, with subversive twists on France’s political ideals: liberty, equality, and fraternity. Each movie stars a different cast, but is interconnected in a shared continuity in subtle and surprising ways. Blue is considered an “anti-tragedy” themed around liberty; White is an “anti-comedy” on the theme of equality; Red is an “anti-romance” about fraternity. And each works their respective color into the scenery in clever ways.Juliette Binoche stars in Blue, a study on emotional liberty, as a widow in mourning for her recently deceased husband and daughter. Instead of remembering them, she goes to extremes to distance herself from her pain. Julie, the main character, tries to withdraw from society and live in isolation, but is drawn back in when she discovers that her late husband had a mistress.In White, Zbigniew Zamachowski is Karol, a man who’s subjected to a humiliating divorce, loses everything, and is reduced to a street beggar. A chance encounter opens his eyes to an opportunity to turn the tables on his ex. It highlights equality in the most unexpected of ways: a sad, lost soul who turns to vengeance to balance the scales of justice. His success is equal parts cathartic and tragic, a tale of revenge served incredibly cold that has a more profound impact on Karol than it does his victims.Red is the most acclaimed of the trilogy, in which Kieslowski looks at the meaning of fraternity by presenting a group of characters with nothing in common whose lives become entwined. The core of the story has young Valentine (Irene Jacob) encounter a reclusive, sullen retired judge named Kern (Jean-Louis Trintignant). Despite his glum personality and detached behavior, Valentine continually finds herself visiting him, trying to uncover the humanity he’s worked so hard to hide. There’s much more to it of course, and the finale assembles Kieslowski’s jigsaw puzzle together in poetic fashion.8. BACK TO THE FUTUREChristopher Lloyd and Michael J. Fox in Back to the Future The Best Movie Trilogies Of All TimeNarratively speaking, Back to the Future is a perfect movie. Every line of dialogue and plot point matters, every conflict introduced is resolved in a pulse-pounding, brilliantly tidy way. It creates rules of time travel that rely on a MacGuffin (either the DeLorean or the Flux Capacitor, take your pick), yet those rules make logical sense and the movie never violates them. Amazingly, Back to the Future does a remarkable amount of world-building without putting the whole world in jeopardy; it’s a story that revolves entirely around the lives of one family.Who didn’t thrill to the story of Marty McFly (Michael J. Fox), wannabe rock star who goes thirty years back in time, saves his parents and transforms his loser family unit into a happy, loving, successful household. He gets the girl (though technically, he never lost her), prevents his best friend from dying, and saves the day. He even invents rock ‘n’ roll. It was a box office triumph.Back to the Future Part II had impossibly high expectations to live up to, but its main story arc suffered from a lack of creativity and remake fever (the wholly unnecessary return trip to 1955). On the other hand, time and distance have bestowed Part II‘s first act with rose-colored glasses, as all of its ideas about the future have embedded themselves permanently into our everyday vernacular: hoverboards, wearable technology, flatscreen televisions, smart homes, tablet computers, and much more.Part III injected more originality into the mix, taking our heroes back to the Old West and relying less on repeating the same old story beats. It culminated with a finale set aboard a runaway train that managed to up the intensity over the first film’s stormy showdown, not to mention introducing a love interest for Doc Brown (Christopher Lloyd). Neither sequel quite lived up to the first film’s jolt of crisp storytelling or justified turning a truly fantastic film into a good-not-great trilogy.But there’s no denying that Back to the Future is one of the greatest adventures ever put on film.7. CAPTAIN AMERICAChris Evans as Steve Rogers in Captain America Civil War The Best Movie Trilogies Of All TimeCaptain America: The First Avenger introduces us to Steve Rogers (Chris Evans), a pure-hearted American who wants to serve his country in World War II. But Rogers is a weakling with no strength and no skills to speak of, aside from a keen tactical mind and an unerringly straight moral compass. When he’s injected with a super-soldier serum, he becomes Captain America, the country’s first superhero and a central figure in defeating the Nazis.It also introduces us to Steve’s best friend, “Bucky” Barnes (Sebastian Stan), who is presumed dead in the second Great War after falling from an impossible-to-survive height. Bucky nevertheless returns in the modern day in Captain America: The Winter Soldier, much like Steve, who’d been frozen in ice beneath the Atlantic during First Avenger‘s final battle. Bucky, it’s explained, was saved and abducted by Hydra, and brainwashed into the titular consummate assassin, complete with a metal arm and mad wetwork skills. While Steve wrestles to put a corrupt S.H.I.E.L.D. out of business, Bucky is used as a tool of his enemies, but Cap finally manages to get through to him before the movie’s end.Captain America: Civil War, the conclusion of the trilogy, would have been such an easy misfire. Focusing on the comics’ story of the same name, it presents the Avengers — and their leader, Captain America — with an ultimatum about superheroes falling under the supervision of world governments. It also features a major conflict between Cap and Iron Man. And it’s no small miracle that it manages to do right by a dozen major characters — including introducing Black Panther (Chadwick Boseman) and the new Spider-Man (Tom Holland). But filmmakers Joe and Anthony Russo wisely keep the story’s heart entrenched in the bromance between Steve and Bucky, now reformed but still capable of being “activated” as the Winter Soldier with the proper sequence of phrases. This allows Steve’s relentless pursuit of saving his friend to form the through-line for the entire trilogy, showing that Cap would go so far as defying the law if it meant helping his oldest pal. As superhero movies go — not to mention an integral part of Marvel Studios’ connected universe — that’s some profoundly emotional stuff.The Captain America films may not be three parts of one story, but their characters forge an emotional journey that viewers can easily track from one flick to the next. It also accomplishes the unprecedented task of besting itself with each subsequent entry. (How many other trilogies can you think of where the third movie is the best of the series?)When it comes to the Marvel Cinematic Universe, Iron Man may get all the attention, but Captain America is the crown jewel.6. INDIANA JONESHarrison Ford as Indiana Jones in Raiders of the Lost Ark1 The Best Movie Trilogies Of All TimeYou may be tempted to think of George Lucas as a one hit wonder. Sure, he had a few smaller successes here and there — American Graffiti, Willow — but aside from a galaxy far, far away, his career hasn’t exactly been filled with beloved classics. Radioland Murders wasn’t awful. Red Tails should have been better. Strange Magic? Uninspired. And the less said about Howard the Duck, the better.But there is that other franchise that Lucas is known for, the one he teamed with BFF Steven Spielberg on. Once again drawing on his love of matinee serials, Lucas dreamed up a swashbuckling archaeologist named Indiana Jones, a bookish professor who becomes a rough-and-tumble adventurer when some ancient treasure caught his attention. The fact that his exploits often brought him into conflict with forces of evil, such as Nazis, was almost coincidental; he never set out to be a hero. But his world-weary determination, rascally charm, uncanny knack for survival, and wry sense of humor always kept us coming back for more.His first outing, Raiders of the Lost Ark, was a near-perfect movie in every way. Spielberg’s kinetic direction brings Lucas’ vision to life with spontaneity and excitement, while Lucas’ plot centers on one of the most sought-after relics of all time. Their concoction was the role Harrison Ford was born to play, despite not being Lucas or Spielberg’s first choice. Indy was surrounded with colorful, mustache-twirling villains and a beautiful, strong-willed woman (Karen Allen, who was anything but a damsel). With his fedora, leather jacket, and bullwhip in hand, a new kind of movie hero was born, and he’s one that’s lasted through multiple generations.Indiana Jones and the Temple of Doom begins with a thrilling action sequence set in a Shanghai nightclub, followed by a daring escape from a crashing airplane. When Indy, his sidekick Short Round (Jonathan Ke Quan), and hilariously exasperated new love interest Willie Scott (Kate Capshaw), arrive at Pankot Palace, they discover the terrifying temple of the Thuggee cult, who make ritual human sacrifices and enslave children. For a good thirty to forty-five minutes, the movie descends into an oppressively bleak look at an evil-worshipping cult. Thankfully, things pick up again before the end, culminating with an unforgettably thrilling mine cart chase.Indiana Jones and the Last Crusade restored the lighthearted feel of the first film, sending Indy on a quest — aided by his father (a cheeky Sean Connery in one of his best performances), no less — to find the Holy Grail. Those dastardly Nazis reared their ugly heads again, there were sensational chases through Venetian canals and Jordanian deserts, and this time there were two Dr. Joneses to save the day.We’ve chosen not to include Indiana Jones and the Kingdom of the Crystal Skull, as the first three movies form a winning “original trilogy” a la Star Wars. Besides, Crystal Skull is a “19 years later” sequel that lost the plot by following the rabbit trail of Indy’s long-lost son (Shia LaBeouf) — a storyline Lucas stubbornly insisted on pursuing, even though it never works. With Lucasfilm now in Disney’s hands (and Lucas himself out of the picture), plans are in motion for a fifth Indiana Jones film, which will hopefully wash away the meh taste left by number four.5. THE DARK KNIGHT TRILOGYChristian Bale as Batman in The Dark Knight The Best Movie Trilogies Of All TimeWhen Christopher Nolan was handed the keys to the Batmobile, he knew that the only way he could make a superhero movie was to do it as realistically as possible. That meant he had to approach the Batman mythos as if it were something that could truly happen. No superpowers, no fantasy or science fiction, no standard comic book stuff. It would be drama that rang true, performed by serious actors, almost literary in quality.To truly appreciate the achievement that was Batman Begins, you have to remember the Bat-flick that came before it: the abysmal Batman & Robin. Nolan’s instinct was to get as far away from that silly, hyper-colorful fantasy as possible by grounding his movie in the real world. One of the smartest ways he did that was to avoid lazily relying on CGI visual effects, instead staging enormous, elaborate sequences with real objects, such as the amazing tractor trailer that flips end-over-end in The Dark Knight or the mid-air jailbreak that opens The Dark Knight Rises. Nolan is also singlehandedly responsible for bringing IMAX cameras to blockbuster movie-making, leading to the format’s adoption by other filmmakers and an exponential rise in its popularity.But none of these things would matter if the Dark Knight Trilogy wasn’t a master class in cinematic storytelling. Or if Nolan hadn’t cast high-pedigree actors like Christian Bale, Gary Oldman, Morgan Freeman, Michael Caine, and a bravura turn by the late Heath Ledger as a different kind of Joker, among others. The high point is inarguably The Dark Knight, which is widely regarded as the finest superhero movie ever made.Unlike other superhero sagas, the Dark Knight Trilogy boasts genuine, bonafide closure. We got to see Batman Begin, after all, so why shouldn’t we witness his end? Nolan must’ve felt the same way, as he gave his hero and his trilogy a definitive conclusion.4. THE GODFATHERAl Pacino and Marlon Brando in The Godfather The Best Movie Trilogies Of All TimeIt should come as no surprise that the celebrated saga of the Corleone mafia crime family ranks highly on our list. The first two films in particular are treasured classics for a myriad of reasons. It defined the careers of director Francis Ford Coppola, stars Marlon Brando and Al Pacino, and novelist and screenwriter Mario Puzo. It won a total of nine Academy Awards, including Best Picture for the first and second films.A moody, fully-realized world is introduced in the soft lenses and mud-colored cinematography of The Godfather. The film told the story of Michael Corleone (Pacino), a World War II veteran who returns home to his Italian-American family in New York and becomes deeply embroiled in the mafia war his father is waging. At its barest of bones, the first film is a tragedy about a good man who goes bad, albeit in part as a result of the circumstances around him. It ends with the death of his father Vito (Brando), and Michael taking his place as the head of the Corleone family.The Godfather Part II, the first sequel to ever win Best Picture, continued Michael’s story as Don Corleone, charting his schemes and sins to come out on top over rival crime families. Robert de Niro appeared in flashback scenes as a young Vito Corleone, depicting the patriarch’s rise from Sicilian orphan to mob boss. Pacino’s nuanced performance in Part II is considered one of the best of all time, and the movie became the rare example of a sequel that’s as cherished as its progenitor.While two years separated the first two movies, Part III came after a 16-year gap, which may explain why it never achieved the same success as the first two. Coppola designed the finale as the “epilogue” of Michael’s story (which he believed was complete after Part II), with an aging Michael Corleone trying to atone for his sins while appointing a successor (Andy Garcia).The first movie is one of the most quoted films of all time, even though it’s brimming with stereotypes. The genius of the Godfather saga is how masterfully it weaves those very cliches into a tapestry so compelling, you can’t take your eyes off of it.3. TOY STORYWoody Buzz and the gang in Pixars Toy Story 3 The Best Movie Trilogies Of All TimeIt’s the best-reviewed trilogy of all time. Rotten Tomatoes shows that critics adored all three movies across-the-board. Only the second film scored less than 100% approval, instead landing 99% of critics’ adoration. (Which can only mean that one critic somewhere out there had a migraine on review day.)The first movie was a perfect confluence of circumstances. In Toy Story, Pixar changed animation forever by showing the world that computers could produce imagery every bit as expressive and alive as traditional hand-drawn animation — if not more so. John Lasseter and his cohorts created the first-ever feature-length CGI movie and wowed the world. Technical achievements aside, Toy Story succeeded because it’s an ingenious story, at once both original and timeless. Lasseter filled it with timeless characters and archetypes anyone can identify with. The stalwart cowboy hero (Tom Hanks), the delusional space ranger toy who thinks he’s real (Tim Allen), the cast of kooky sidekicks, each with a distinct personality. Pixar built a vivid world with its own rules and used it to tell a fable in the classic Disney vein.Toy Story 2 had Woody discovering he was a valuable collector’s item based on an old TV show, forcing him to choose between joining other toys from that same show to live in a museum or returning to the little boy who loved him. It also introduced some great additions to the cast, like cowgirl Jessie (Joan Cusack) and Woody’s loyal horse Bullseye. Toy Story 3 was the series’ emotional powerhouse, a masterpiece that had Woody, Buzz, and the gang literally staring down their own mortality as Andy grew too old to want to play anymore. The heartbreaking, impossibly beautiful finale was as blissfully perfect an ending as any trilogy could possibly achieve.A fourth Toy Story is coming, but Pixar has said that it’s something completely new and not part of Andy’s story, so we believe the first three films still constitute a trilogy. Toy Story 4 will be a love story between Woody and Bo Peep, who fans will remember was “lost” by the time of Toy Story 3.2. STAR WARS: EPISODES IV-VIMark Hamill as Luke Skywalker in The Empire Strikes Back The Best Movie Trilogies Of All TimeThere is truly no limit to the influence of the preeminent pop cultural touchstone that is Star Wars. The three original films in the series are undoubtedly the most treasured film trilogy of all time. Did anyone even make movie trilogies before Star Wars came along? Back in 1977, no one could have imagined how Star Wars would change movies, pop culture, and yes even the world, forever. Can you picture a world without Luke Skywalker, Han Solo, or Princess Leia in it? What about Chewbacca? R2-D2 and C-3PO? Yoda? The Jedi, the Force, and lightsabers? The Death Star (er, Stars)? X-Wings?It’s a classic wish-fulfillment fantasy: a young man (Mark Hamill) who’s bored with his humdrum life is propelled into a life of adventure, learns he has special abilities, and must rise to the challenge to save the entire galaxy. He meets an old mentor (Alec Guinness) who guides him on his quest, where he makes allies and enemies, discovering a destiny that only he can fulfill along the way. It’s a familiar formula that countless stories have drawn upon, but it came at a unique moment in history. In 1977, the Vietnam War was still lingering in Americans’ minds. President Nixon was smack in the middle of the Watergate scandal. New York was being terrorized by the Son of Sam murders. The Cold War was heating up, and the entire world was facing an energy crisis. Is it any wonder that this powerfully earnest story format struck a nerve in a cynical world?The Empire Strikes Back arrived in 1980, wowing moviegoers with a second chapter that took Star Wars to the next level. A bigger budget, a seasoned director, a darker story, and a genuinely shocking revelation about Luke Skywalker’s parentage was a perfect formula for a follow-up, and to this day it ranks as the highest-rated entry in the saga. Return of the Jedi wrapped up the story in 1983 by resolving Empire‘s cliffhanger and destroying both Darth Vader and his Emperor once and for all.More movies followed, with George Lucas directing a prequel trilogy between 1999 and 2005, which was heavier on visual effects but disappointingly inferior on story and character. More recently, with Disney’s acquisition of Lucasfilm, a new trilogy was kicked off, with fans proclaiming it a return to the revered sensibilities of the original trilogy. A series of standalone films set in the Star Wars universe are also in various stages of production.Add in the full empire of tie-in products and media — books, toys, television, games, music, and so much more — and the full cultural impact of Star Wars may be immeasurable.1. THE LORD OF THE RINGSSauron in The Lord of the Rings The Best Movie Trilogies Of All TimeProbably the greatest modern example of a single story told in three parts, The Lord of the Rings is our pick for the best and truest example of a “pure” trilogy. Many have tried to imitate its formula, but nothing can really compete with J.R.R. Tolkien’s fantasy saga, retold on the silver screen by director Peter Jackson. There’s just no better way to do it than to script, plan, and prep three movies entirely in advance, and then film all at once. The result was a combination of production design, costumes, makeup, cinematography, music, visual effects, acting, and more that enjoyed a consistency so perfect that no other trilogy even comes close.This achievement can’t be overstated. The only other instance on record of an entire trilogy being filmed all at once is Peter Jackson’s Tolkien prequel, The Hobbit (which didn’t need to be a trilogy at all). James Cameron has stated his plans to film the second, third, and fourth Avatar films all at once, but who knows if that’s what will wind up happening.In 2001’s The Fellowship of the Ring, Frodo Baggins (Elijah Wood) is given the sacred mission of carrying the most dangerous object in existence — a golden ring of unprecedented mystical power — into the most evil realm on earth, to the one place it can be destroyed. He’s accompanied by a colorful cast of Hobbits, men, a powerful wizard, an elf, and a dwarf. They’re dogged at every step by wicked creatures working for the dark lord Sauron, who requires the ring to restore his power and subjugate the world. Kind wizard Gandalf the Grey (Ian McKellen) makes the ultimate sacrifice, while CGI wonder Gollum (Andy Serkis) is glimpsed for the first time.The fellowship is divided into three groups in The Two Towers (2002), each going in different directions but all working toward the same goal of saving the innocent and defeating Sauron. The pressure was on for Jackson and company to deliver a follow-up that improved on its predecessor — no small feat considering The Two Towers is a story without a beginning or end. A number of major new characters are introduced as we’re treated to looks at all new locations in Middle-Earth, along with the exhilarating Battle of Helm’s Deep.The story ended in 2003 with The Return of the King, in which Viggo Mortensen’s Aragorn finally embraces his destiny, Frodo and his faithful friend Sam (Sean Astin) succeed in destroying the ring, and Sauron is destroyed. King is a powerhouse punch of emotional impact, providing eye candy on an astonishing scale and paying off every plot thread introduced by the trilogy with beautiful closure for every character.The Lord of the Rings is essentially a ten-hour movie, and a masterpiece in every sense of the word.