Surviving In This Very Moment…

My Personal Battle with Prostate Cancer … And Life!

Archive for the tag “Cancer”

Weathering the Storm…Nine Months Later but Who is Counting

Weathering the Storm...Nine Months Later but Who is Counting

Weathering the Storm…Nine Months Later but Who is Counting

At six-o’clock in the morning on Sunday I am sitting in my hotel room in Kansas City, Missouri listening to the thunder as the tail end of a violent Spring storm passes by. Looking at the weather radar I can see another small cell approaching from the southwest. Last night the weatherman reported that there was a 60% probability that one would be exposed to a violent storm, possibly a tornado during the afternoon hours when I will be in Denver. Lucky me.

All this got me to thinking that I was and always have been lucky. Most recently, when I was diagnosed with aggressive prostate cancer in September of 2012. What could be lucky about hearing the words, “You have cancer,” you ask? At the time, I didn’t think it so lucky either but then, after all the testing, the poking and prodding, I learned that the tumors were likely (but not positively) encapsulated in my prostate and that surgery would be the most aggressive ‘cure.’ The decision to operate took place in October but, because of the swelling of the prostate due to the needle biopsy, surgery had to wait until late November. That thirty day run-up to surgery was a nervous time, a time in which I thought a lot about my own mortality.

As long time readers know, the surgery was successful, the tumors were, in fact, contained within the prostate; it became clear that life would go on. Of course, I was left with two significant side-effects of prostate surgery. I suffered significant incontinence requiring me to wear diapers for the next five months. As I write this today, I am confident that the incontinence will not be a problem much longer if at all.  This, of course, answered a significant question I had for many years, namely, “Just who would wear Depends for Men anyway?” The surgical procedure was said to be nerve sparing so that sexual functioning would not suffer. Oops, that side-effect remains intact. I think of this as a small price to pay for a long life expectancy; who knows, I’m told this is likely not permanent either.

Since the surgery, however, I have suffered two major setbacks. First, I had a significant urinary tract infection, one that was resistant to many antibiotics, requiring that a permanent line be attached to a vein in my arm for daily injections of some potent antibiotic. While this seemed to do the trick (the infection is gone) I was diagnosed with chronic kidney failure with a kidney function of under 20%. While the reason for this seems to baffle both my internist as well as a kidney specialist I am seeing, the last kidney function test showed a marked improvement in kidney function. The worst seems to be over. Lucky again.

Good, because on Wednesday I will arrive in Las Vegas to play a little poker. While I don’t think of poker as a game of chance, winning always involves a bit of luck as well as a great deal of skill. So, as I go to Las Vegas, I’ll wear the cloak of luck I seem to have been wearing for the past 70 years, one that has allowed me to weather most every storm I have encountered. 

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No More Roman Numerals

No More Roman Numerals

No More Roman Numerals

I can’t imagine what I was thinking when I started the “Thinking in Jewish” series of posts by numbering each post with a Roman numeral. This numbering system is antiquated and cumbersome and I am, quite frankly, tired of the whole mess. So from this day forward I will number the “Thinking in Jewish” posts using Arabic numbering system which means that the next post will be labeled 32.

There is a question I want to answer for the readers of this blog. It comes up from time to time in the comments which makes it a worthy topic to blog about. It centers on what on earth my atheism and the posts in the series “Thinking in Jewish” has to do with my prostate cancer diagnosis and treatment. Along the same lines I have seen a strange undertone that seems to be asking what is an atheist like myself doing commenting on Jewish thinking in the first place.  So here goes…my best effort at talking about these issues as I blog away.

Begin at the beginning. When I heard the words no one ever wants to hear, the words that may indeed harken the beginning of the end of life, the words “YOU HAVE CANCER” it has a sobering effect on the way one chooses to look at the world. In my professional life I was a Professor of Language and Literacy at a Midwestern state university. My professional interests gravitated toward the study of the teaching of writing so that middle school and secondary school teachers could better teach their students the skill of writing without effort. Blogging, then, seemed like the most natural thing I could do to both help me focus on the fact that I now have a disease that may contribute to my demise. Kubler-Ross was wrong in my case. I grieved over the possibility that my life was coming to an end but I quickly accepted that as a fact that may or may not be true. My job now was to come to grips with how I intended to live the remaining years (or months whatever the case may be) of my life.

As an atheist, I rejected the idea that there is a creator God that is omnipotent, omniscient, and benevolent. My own observations of the world and my deepening understanding of Jewish religious texts, however, caused me not to reject my own Jewish roots. I am a Jew, I have a Jewish understanding of the world, of time and space, of ethics and morality. I simply don’t attribute any of this to a creator God. one that is angry, demanding and punishing. As a post-Shoah (or post Holocaust although Shoah is a better word choice) Jew, where 6 million of my nation perished at the hands of Germans in an unspeakably horrible genocide (perhaps religicide is a more apt descriptor) for no other reason than they were Jews in Europe, made the very concept of a benevolent and omniscient God improbable and the very idea than an omnipotent God would not put a stop to the horrors of the camps, gas-chambers and crematory ovens would make this God either a sadist or rather than omnipotent, simply impotent and unworthy of worship. The other possibility to consider is that there is no God to be omnipotent, omniscient or benevolent, a possibility I find more convincing than any that includes God or religion at the center of the a discourse.

While sick and waiting for testing to be completed to determine what course of treatment for my prostate cancer would be recommended, I decided that learning how to ‘think in Jewish’ would be a good way to think about the potential end of life. It was a clear choice. The Christian story makes absolutely no sense to me. The same can be said for the story of Islam although that one is easier to swallow perhaps because it was formed in the same region as the Jewish story while the Christian story, while originating in Palestine, is essentially a European take on the very idea of monotheism. That being said, I thought it best to stick with what I know and simply become better at understanding where and how the religion of my people developed. The story, especially when told in the light of the ultimate schism of Jewish and Christian thinking and the response of both to the Roman destruction of the Second Temple in Jerusalem in 70 CE, is fascinating. I do not intend to go into that schism here but the response of the triumphal Christians and the defeated Jews of the first three centuries CE paints a picture of quite different approaches to the self-same problem.

What I found as I studied and read more deeply was that the ethics of Judaism played a great role in the way I had been living my life for years. There was embedded in the literature constant reminders of obligations to care for the widow, the orphan and the stranger, for those less fortunate than we might be and there is always someone less fortunate than yourself no matter what your current situation might be. I don’t recall who said this but it is appropriate here. It goes something like this, “I cried out because I had no shoes until I saw a man who had no feet.” Sure I had cancer, but I still had hope and that hope lay in the hands of skilled physicians, men of science, who would do everything possible to make the remainder of my life one filled with the absolute joy of living. In the end, the men of science told me that surgery would cure my cancer and while there are some unpleasant side effects of the surgery, my life will not be disrupted to any great extent. I am now writing as a cancer survivor, one experiencing the unpleasant side effects and it is truly a small price to pay for many more years of life.

That being said, I decided to continue this blog because my personal struggle with ethics and evil in this world has become an important part of my life. Sure, it didn’t begin when I was diagnosed with cancer but that diagnosis brought it to the forefront of my being-in-the-world. That is why I continue to blog about my encounter with life in general and sometimes about health related issues that seems to arise as a result of my experience with cancer.

So no more Roman numerals and I’ll continue to make my thinking visible to me (and to you) on this blog.

Infusions, Doctors and Life Generally

Infusions, Doctors and Life Generally

Infusions, Doctors and Life Generally

As I was sitting in the very comfortable reclining chair getting hooked up for my sixth infusion of antibiotics to deal with the  resistant echoli strain that has seen fit to invade my body, I was struck by the idea that since my cancer diagnosis, surgery, and recovery period, I have slowed down. Now slowing down is a good thing. It began when I took off my watch forcing me to be less concerned with time in general. While the act of refusal to recognize time as a constraint was difficult at first, it has become a blessing. To not feel the urgency of time makes the time I have more precious; something akin to a gift from myself to myself. At the same time, I have not lost my appetite for punctuality. This may seem a contradiction but I think it is not. When everything is run by the clock then punctuality is an obsession but when I take the time to just take in what is there, punctuality becomes an ethical act; an act of respect for the other whether the other is driven by the clock or not.

So sitting in that chair, talking to Cynthia, the nurse administering the antibiotic, I noticed all of the surroundings, the pictures on the wall, the clock with the broken second hand, the smell and taste of the antibiotic as it drips into my veins. In the moment of that half hour of dripping solutions I was at one with the universe.

Since taking off the watch six or so months ago the world seems to spin at a slower pace. Of course it isn’t the case but the fact that I take the time to notice things I didn’t have the time to notice before is a bonus that was totally unexpected. I hear the voices of doctors as they try to figure out what is going on with me and find the urgency of one doc countered by the patience of another as they look at the results of the data. One doc looks at a number and nearly panics while the other looking at the same numbers takes the approach of waiting to see how the whole picture develops before striking out with a treatment plan. I think that one should never treat a number, rather one should look at the whole picture and treat the cause of the abnormal data that emerges over time. Jumping in without all the facts is as dangerous as denial of the emerging data. While one cannot be absolutely certain when incomplete data is present, one cannot allow oneself to be driven by the presence of a single abnormal number either. That too is an insight I learned after taking off my watch and allowed myself the luxury of observation.

As an aside, I found it interesting that even with the PICC line inserted I had to be stuck to draw blood in my internist’s office. What a waste of a good PICC line. When in the infusion center blood was also drawn and the same blood numbers will be analyzed. Why twice? Could it be profits are involved?

 

By the Numbers

The most important number I saw yesterday was a PSA of less than 0.01, essentially no prostate cancer remaining six months post surgery. That was very good news but not unexpected. Everything else was normal or bordering on normal with a few slight adjustments. More to come later

 

PET Scans to Image Prostate Cancer Advance Toward Mainstream Clinical Use – Prostate Cancer Foundation PCF

An interesting development in diagnosing prostate cancer. Click to read the article from the Prostate Cancer Foundation

PET Scans to Image Prostate Cancer Advance Toward Mainstream Clinical Use – Prostate Cancer Foundation PCF.

Thinking About the Other (Person)

On November 14, 2006, I wrote in my journal:

The trace is othered when the trace places the solitude of the self in contact with the knowledge of the other. The other does violence to the solitude of the self in the sense that the other creates a break, a tear in the condition of solitude, the only experience of the trace. The tear disrupts the hegemony of the self by offering up a knowledge that there is something external to the trace which is otherwise a self-contained existent.

Thinking About the Other (Person)

Thinking About the Other (Person)

The notion that the trace is a remembrance isolated, belonging only to the self, that is capable of being torn from the self by the appearance of the other is an important way of thinking of the difference between the encapsulation of the self in isolation and the efference of the self experiencing the other as other.

I cannot share the trace I have constructed from this very moment with any other human being. My trace belongs exclusively to me. To share trace as a record of a lived-experience is quite impossible for two important reasons. First, because trace is something akin to embedded memory and because memory is an unreliable source for recalling a past event in a lived-experience, whatever I share can only be something of a partial exposure of that lived experience. Memory tends to disgorge that which is unpleasant, uncomfortable, or is damaging to one’s projected image. Time softens memory so that we forget that which was forgettable and enhance that which can be recalled safely. Secondly, even if one could share a trace as a true recording, the time it would take to retell would be equal to the time it took to record the trace in the first instance. Reliving a lifetime would take a lifetime to retell.

Once the other tears the hegemony of the self by making itself present to the self, once the self becomes aware of the other as a fully formed existent, the potential for shared experience is open and on the table. This does not, however, include the idea that a shared trace is possible. No, even when two or more people experience the very same event, when they witness something, their individual perspective will not accommodate a shared trace. The event will be viewed from different perceptual points, even when the witnesses are standing right next to one another. Next to is not the same as the position of the self. In addition, cultural and linguistic differences will cause each self watching an event to see the event through a lens of cultural and linguistic taken-for-granteds that, while appearing to the individual as perfectly normal, will appear to the other as unusual, different, out of touch.

The truth of being-in-the-world is that we are all self and we are all other! The distinction is that each self is uniquely different from every other and each other is uniquely different from each isolated self. This, then, leaves open two distinct possibilities: first, that the self reduce the other to the same, that the self create categories or cubby-holes to effectively isolate the other as a stereotype, of belonging to a particular class (e.g., teachers, union members, thieves, blacks, Jews, Mexicans, and so on) in which a conversation about, say, teachers begins with “all” as in all teachers are (fill in the blank). Secondly, one may choose to look at the other as unique and embrace the differences that each and every other encountered brings to the social encounter. Rather than lumping into a hegemonic category, this approach embraces the diversity each of us brings to the encounter allowing one to take away something positive rather than encapsulate one’s taken-for-granteds about any single group as an excuse for hate, rage and violence.

So what, if anything, does this have to do with the fact that this blog is about my surviving prostate cancer in this very moment? Simply this, I have cancer but I am not governed by the fact that I contracted this disease. Oh at times I am absolutely required to respond to something or other because of the disease but I am not ruled by nor do I identify myself as only a cancer patient. Quite the contrary. I am more than my disease. In fact, I am made of many facets, each of which are part of my lived-experience. Only one small part of that lived-experience has anything to do with my personal struggle with disease. So, yes, sometimes I ramble on about things that interest me because it provides an opportunity for me to present myself to the other in such a way as to embrace the Levinasian fundamental ethical obligation without reservation. As a self I announce my responsibility through any number of means and then I wait to hear the demand of the other.

In Every Sorrow There Is Profit

“In every sorrow there is profit” (Proverbs 14:23).

The weather forecast is...rain!How can a sorrow turn a profit? Let me relate this to my own sorrow, my battle with prostate cancer. The words, “You have cancer,” even when these words are somehow expected given the circumstances, are stunning. In my particular case, these words placed me in immediate confrontation with my own mortality. I certainly understood that life itself is a terminal condition; that one cannot expect immortality or at least a corporal immortality. I knew that I was going to die someday but suddenly the prospect seemed utterly possible.

The cancer was discovered through needle biopsy prompted by the fact that my PSA had a range of 21 to 26. The cancer biopsy found about 5% of three samples had a Gleason Score of 4+4, making the cancer itself quite aggressive. In consultation with my urologist, internist and my wife, I decided to follow the recommendation of the urologist opting for a robotic radical prostatectomy, a procedure that would provide me with the best chance for a “cure.” Since my bone scan was negative for metastasis and my CAT scan was mostly negative for metastasis (because I have a great deal of titanium shielding my pelvic area (two replaced hips and a laminectomy l-3 to s-1) the pelvic area being a question mark, the diagnosis of non-metastatic cancer was on hold until the biopsy of the lymph nodes surrounding the prostate. All that was hard to swallow especially when I had to wait a month for the prostate surgery to take place because the gland was swollen due to the needle biopsy procedure.

The instant one learns that one has a potentially fatal disease, prostate cancer is the second leading cause of death in men, the prospect of eternity becomes real. But what exactly does eternity mean? For me, the prospect of eternity means a reversal of the transition of exiting one infinity, a condition that is emergent at the very moment of birth to the transition of returning to that very infinity at the very moment of death.

This transition is one in which one moves from existential time, the lived-experience, to archival (remembered) time, the traces left behind for friends and family and possibly for others outside a direct connection to the self. The first time I heard the words spoken aloud, “You have cancer,” it was like a kick in the head. The last time I experienced such a sensation was when I heard the not unexpected words, “Your father is dead.” Everything stops, stands still, refuses reality. It is the first stage of any sorrow, that of denial. I found a quiet place to sit, to embrace the stillness, the silence that surrounded me. I wanted to be completely alone, to sink into myself allowing me to feel sorry for the loss or potential loss that is approaching. In very real terms, I found myself embraced by and embracing a deep sorrow. In poker terms, however, I had a few outs. Not all the cards were played and not all the possibilities were known.

Infinity

Infinity

I soon discovered the profit promised in the proverb that inspired this post. The strength I had working for me was the fact that I had some outs; that there was the possibility that the surgery would be curative so rather than facing immediate mortality, I would be safe, at least from this disease, for some time to come. This gave me the strength to rethink the ethics proposed by Emmanuel Levinas summarized by what Hillary Putnam called the fundamental ethical obligation: I am responsible for the welfare of the other without reservation or expectation of reciprocity! This fundamental obligation provides one with the ability to live in this very moment, the moment of existence, without projection and without memory in the sense that what is done is done and, without reservation, one cannot dwell on regret as a predominant emotion to the traces of the past.

The sorrow imposed by prostate cancer provided the opportunity to profit from the knowledge that Here I Am! responsible for the welfare of the other, the fundamental ethical obligation, as a call to live ethically in this very moment. Living in this very moment is both exciting and freeing. I can’t imagine living anywhere else.

Bittersweet News For Sure

Bittersweet

Bittersweet

Finally, I spoke to my urologist yesterday. Here’s the scoop. At the time of surgery the cancer had invaded 35% of my prostate and a small percentage had nearly reached the margins of the gland. The Gleason Score for the tumor was an overall 4+4 (or in simpler terms an 8) meaning that this was an aggressive tumor. The biopsy of the lymph nodes was clear of any indications of disease. It seems that surgery was the right choice…hooray! Sadly, however, my urologist, a man who has cared for my prostate and other urological problems for years, is leaving his current position to accept a huge promotion around 200 miles from Chicago. Good news for him and I’m sure I’ll get over the shock of a new urologist.

So once again, life throws a curveball. One reason I never advanced as a baseball player is the simple fact that I couldn’t hit a curveball no matter how hard I tried. Catching up to a fastball, no problem but that damned curveball would never hold still long enough or be in the expected place when I took a swing at the pitch. Once I gave up playing kids games, however, I learned that life’s curveballs, difficult as they might be, are always subject to a period of adjustment. It is almost like Kübler-Ross’s stages of grief with acceptance being the ultimate goal. I found that coming to acceptance is a matter of deciding what the worst possible outcome is, accept that outcome and work hard to see that that outcome is avoided if at all humanly possible. Acceptance is, in this sense, an active step; one that requires a positive approach to any difficult situation.

Look, I know that grieving over the loss of one’s urologist is maybe a bit crazy, but the end of any relationship is always difficult, especially one that is long-standing. It is, however, just one more example of how I can use the ethical tools I am developing to remain on an even keel during times of hardship, great or small. In this case, I turn outward and, rather than feeling sorry for my loss, I feel a sense of joy for this extraordinary physician and care-giver. I wish him well and I am absolutely certain that he will hook me up with one of his partners who will afford me the best of care, albeit, most likely without the smiling bedside manner that separates him from the crowd.

Here I Am!

Abstract

Abstract

Sometimes I wonder just how many significant opportunities to escape the mundane, day to day activities of life are offered up in a single lifetime. A group I belong to, one that relies on platitudes to make a point, drills into its membership that one must live life on life’s terms. For the most part, that means accepting the humdrum of a random life, one that offers up both challenges and boredom, and mostly boredom. So perhaps the question of escaping the day to day absurdity of the lived experience is not the goal, rather the challenge is to learn to live with the chores of existence while being open to the challenges that sometimes come along.

Challenges appear without notice. There is no announcement that a challenge will present itself on Wednesday at 7:47 AM so be ready. No, challenges strike randomly from apparently nowhere in particular. They are random occurrences that follow the mathematical laws of probability.  Most challenges sort of creep up on you. Once noticed, they don’t seem to have a point of origin. They are suddenly just there, presenting themselves in a way that causes one to remark, “Where did that come from?” Others present themselves suddenly, without any real warning even when a point of origin can be readily identified. The evening after my bone scan and CAT scan, sitting at the dinner table, when my urologist called and said, “You have prostate cancer,” proved to be one of the latter challenges. Those words were like a glass of cold water being thrown in my face, a wake-up call that, while perhaps anticipated, came as a shock.

Challenges offer one some choices. In the case of my diagnosis of prostate cancer, the choices were quite simple. I could turn inward, sit on the pity pot, sink into a depression or I could choose to become an advocate for life, to turn a theoretical ethics into a practical ethics, to become available for myself and for others. I chose the latter as being the only reasonable approach. I chose to live life on life’s terms. This is not to say that I didn’t make aggressive treatment choices, I did. A prostatectomy is major surgery even when done robotically. I chose this approach because it provided the best possibility for a long-term “cure,” although I don’t believe there is ever a “cure” for cancer, only a set of survival statistics, probabilities, percentages. If I understand my own mortality statistics, there is a 15% probability that I will die as a result of prostate cancer in the next ten years. Certainly nothing to go into a grand funk over. After all, I am 69 years old and I would think that I have around a 15% chance of dying from anything over the next ten years.

What this challenge has provided for me is something that I could not have anticipated, the ability to turn my humdrum lived-experience into an ethical one. This is not to say that daily living will not still be filled with routine, be commonplace, rather it means that I am always already present for the other. Here I Am! does not mean that sudden changes will occur in my life. To the contrary, I am creating proximate space that may or may not be addressed by the other (person) but the moment it is, the moment I hear the call of the other (person) I must act for the benefit of the other (person)…period. I see this ‘calling’ to be concentrated on benefiting prostate cancer patients but it is not limited to that sphere of influence. To be truly ethical it must not have walls to contain the effort. So, once again, Here I Am! I stand at the ready in proximity simply waiting to be called.

The Evidence for Being is Being

A light blue ribbon symbolizes prostate cancer

A light blue ribbon symbolizes prostate cancer (Photo credit: Wikipedia)

To paraphrase Emmanuel Levinas, the evidence for ontology is the existence of all of us. The problem with making ontology primary is that it simply asks the wrong questions. If one, for example, wishes to make intentional actions the basis of ontology, for each intentional act there are an infinite number of unintentional acts that coincide with it. Say I wish to read a book, in the act of picking up the book (intentional) as the first step in reading, I displace dust surrounding the book (unintentional), crinkle the elbow of my shirt causing additional wear on the fibers woven into the sleeve at the elbow (unintentional), displace a few skin cells that fall as dust (unintentional), cause a bit of wear on the edges of the book that scrape across the shelf (unintentional), and so on. The very idea that in accomplishing an intentional act, we leave unintended traces behind so as to alter the space in which we are interactive beings-in-the-world because we are also changing that very world in which we are beings-in-the-world. It is not enough to be intentional while interacting with the objective world around us if that world is changed even ever so slightly by our intentional actions.

So what does all this have to do with me and my cancer? After all, I am sitting here writing about me and my cancer because, especially as I recover from major surgery, there is little else for me to do but sit, read, think and write. So here goes a brief explanation.

If ontology is not primary, what then is? In Levinas’s world, ontology takes a back seat to ethics. Yet, an ontological announcement is the critical starting point of all of ethical behavior. That announcement, “Here I Am!” is made by the self to the other (person) without reservation and without expectation of reciprocation. It is a bold statement, allowing for the other to respond or not, something that is in the sole control of the other and not the self. Any response from the other is a call to action in which the self becomes available for the other, becomes responsible for the other, by embracing the differences presented by the other to the self. In short, as an aware self, my obligation is to make myself present, wait for a response that may never come, but when it does I am obligated to act for the benefit of the other even to the extent that I may not be benefited by my actions.

I may, for example, see another person drowning. If I am truly present for the benefit of the other, the call to save the person drowning is absolute and I must act even if, in the process of saving the drowning person I drown myself. Now, most ethical choices are not so extreme as to cause one’s loss of one’s own life, but, Levinas’s point is that the obligation extends beyond the self encompassing the selfless.

As I now am facing the objective world as a likely survivor of prostate cancer, I am clearly present in a way I never thought possible prior to this diagnosis. I still do not know if I am completely clear of disease; this will be answered either Wednesday or Thursday. What I do know, however, is that the original diagnosis provided me with a powerful lens with which to look at the objective world. One of the benefits of hearing a diagnosis of cancer is the ability to make the ethical choice to look at the objective world selflessly. Whether or not I am currently cancer free doesn’t much change that point of view. I am now present, Here I Am! I have the ability to reach out in a new and positive way to other prostate cancer, or any cancer patient if, and only if, they join me in this conversation. I have created the proximate space, the invitation to join me in working toward something positive, not necessarily a positive outcome of the disease, rather a lived experience that is both ethical and positive. The ontological announcement provides the pathway to an ethical life and for that I am most grateful.

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