March 2011 Archives

In case you missed my brief mention a few weeks ago, and its original posting back in 2008, here is a video that three Vancouver Film School students made explaining tsunamis (like the recent one in Japan) in a couple of minutes:

It's based on my 2005 article on the topic.

When I wrote about the Japanese earthquake and tsunami the day they happened, my post was optimistic, despite the obvious catastrophe. In many ways, things have turned out worse than they first seemed. Surely the situation in Indonesia and around the Indian Ocean was similarly awful at the end of 2004—and took many more lives—but we didn't have access to horrifying footage like this (watch the whole thing) to reinforce the point.

The argument I made, that Japan's position as a modern country with a robust infrastructure and vibrant economy, remains: unlike Haiti especially, Japan will bounce back quickly. Fewer people died or were injured than would have been in poorer and less-prepared nations from a magnitude-9.0 quake and massive sea wave. Those who are homeless and displaced will find safe places to live, and food, and comfort faster than in many parts of the world.

But the dead, officially more than 10,000 people now, are still dead. More than half that number again, over 17,000 people, are missing. Villages, towns, and cities are destroyed, some utterly annihilated.

Distracted from a disaster by a crisis

That enormity should remain our focus, but it is not. Because the cleanup and recovery in Northeast Japan is now an aftermath. And there is an ongoing crisis at the Fukushima Daiichi nuclear power plant. Since it is right on the ocean near the earthquake zone, I remain amazed that it survived the original quake and tsunami as well as it did, but ever since then, it's been hard to figure out what's going on at the facility: initially the situation seemed under control, then not. There were explosions. Things were going well, then poorly, radiation up, then down, in the soil, in the water, in food. Workers evacuated, then returned.

It's unclear to me how much of what has happened at the plant is an inevitable cascading consequence of the initial disaster, and how much has been made worse by insufficient information, poor analysis, bad decision-making, and incompetence. It is clear that news coverage of the nuclear accident, especially here in North America, has been remarkably poor, stoking worries while ignoring facts, and even confusing such basic distinctions as those between radiation and radioactive substances; between different types of radiation (alpha, beta, gamma); or between dosages and exposure rates (which is like forgetting the difference between miles and miles per hour).

Here are a three quick resources that I've found helpful:

1. XKCD's radiation dose chart and accompanying blog post gives you a sense of the scales of different exposures to radiation. It has some problems, but as a heavily simplified go-to guide, it will help you get your bearings.
2. Well-known blogger Anil Dash's father-in-law is a health physicist specializing in human radiation exposure, so Anil's post on the topic, while brief, provides some additional sane background on which to base your thinking.
3. The Christian Science Monitor (always a surprisingly good newspaper, despite how it was founded) has a good article on lessons from Fukushima about nuclear safety more generally.

It's about Japan, not about us

I'd also like to point out a few things for people here on North America's West Coast who are worried about radioisotopes carried here on the wind. Remember Hiroshima and Nagasaki? Those were open-air nuclear detonations in Japan, and didn't affect people here. There were dozens and dozens of atomic-bomb tests in Nevada (many also open-air), practically in our back yards, and while some radiation levels were elevated, the health consequences have been immeasurable. The Hanford Site in Washington isn't even 300 km from my house, and is the most contaminated nuclear waste site in North America.

CT scans, flying in aircraft, and even living at elevation in Colorado yield higher long-term radiation exposure than any of these other things, especially on the other side of the Pacific Ocean. Oh, and no matter what, taking iodine is of no help whatsoever: the radioactive varieties coming from Fukushima have half-lives so short they decay away (in addition to being dispersed) before even getting this far. Want protection from danger? Get a flu shot next year.

I'm neither an advocate for nor an activist against nuclear power. My main concern has always been that we really don't know what to do with spent fuel and other radioactive waste from the process (just as with nuclear weapons production), and we never have. "Just bury it" seems a paltry approach when we're talking about substances that could be dangerous for tens of thousands of years. We're still doing a poor job of burying the waste of just 65 years of nuclear production.

But we have an industry here and now, and it has its consequences. Let's at least try to understand and handle those rationally, and help Japan work with them, because hysteria won't make it any easier.

And remember the quake and the tsunami, and the 27,000 dead or still missing.

In 1991, I had finished my Marine Biology degree and was part-way through a non-fiction writing diploma at the University of B.C. On Spring Break in March, I visited my parents, who were then living in Toronto. I didn't feel well: tired, cranky, dehydrated, out of sorts in many ways. Each night, I had to go to the bathroom several times, which was unusual for me at the time. I was losing weight. My vision was a bit funny, and I was unusually hungry. But I was only 21 years old, in strong health, regularly riding my bicycle to school.

Perhaps I had a kidney infection, but I wasn't sick enough to see a doctor—I would wait until I returned to Vancouver. When the time came to do that, I was skinnier than ever, constantly thirsty, fatigued, and grumpy as I boarded the plane. I chugged free ginger ales the whole way back across the country. (I later realized this was a bad idea.)

Too sick to wait

I arrived on a Thursday, and was getting even sicker. I phoned my doctor's office as soon as I got home to make an appointment, but the soonest he could see me was Monday. I went to bed. And stayed there. I was too weak and tired to do anything on Friday or Saturday. My roommates were worried about me: they'd seen how much I'd thinned out while I was away, and how much weaker I was.

They decided I couldn't wait till Monday: I was too ill, and I was going downhill fast. They drove me to Burnaby Hospital's Emergency department, no arguments from me allowed. Within minutes of being brought past triage, a doctor smelled my breath and figured out what was going on: the distinctive sickly-sweet scent of ketoacidosis, caused by my body breaking down muscle and fat instead of digesting food.

It was almost certain that I had type 1 diabetes. Sometime in the past few weeks, my pancreas had stopped producing insulin, preventing my body from metabolizing the food and drink I'd been consuming. Glucose levels in my blood had been rising and rising, and every meal and sugary drink I consumed had been making things worse.

A quick blood test confirmed it. For normal people, glucose is dissolved in the bloodstream at concentrations between 4 and 8 millimoles per litre (mmol/L). (Some other countries, such as the U.S., measure in milligrams per decilitre, where those readings would be between 70-140 mg/dL.) That's normal, between 4 and 8. What was my reading that night in the hospital?

Thirty-two! Four times the highest regular reading, and almost off the scale for most consumer blood-glucose measuring devices.

I almost smacked my forehead. I'd learned about diabetes during my biology degree. I had every sign and symptom in the book. But it had never occurred to me that I might develop the condition: I didn't know of any family history, I was a strapping young guy, and yet I was actually older than most people who get the disease. It is an autoimmune disorder, where my own immune system attacked and destroyed the insulin-producing cells in my pancreas, and most type 1 diabetics first develop it around puberty, which is why it's also known as juvenile diabetes.

Learning to manage

But there I was, diabetic. The staff started giving me insulin, rehydrating me, and getting my electrolytes and other body chemistry back in balance. They started to explain diabetes to me in the simplest possible language, but I stopped them and asked if they could track down a textbook. Over the next few days I'd need to learn how to measure my blood sugars and inject insulin to control them, along with adjusting what, how much, and when I ate. Exercise and stress affect things too. I figured if I read some background physiology on the disease, I'd be better prepared.

Soon enough I was admitted to a regular ward, and soon enough after that, feeling healthy and starting to regain some weight, I was bored. But I still needed to learn how to manage my diabetes, something I knew I'd have to do the rest of my life. I learned as much as I could then (I couldn't leave the hospital without the basics), and more afterwards at various clinics over the years.

And for 20 years now, I have managed it. Through university, jobs, marriage, children, and especially during my cancer treatment—which diabetes makes even more complicated—I've been keeping my blood glucose under control. Not too high, not too low. I measure several times a day by poking the end of a finger and having a tiny meter read a drop of my blood. Enough insulin to handle my meals, but not too much. I inject that at least four times daily. Adjustments for exercise. Awareness of how it feels if my blood glucose suddenly goes low, and what to do about it (quick answer: down a can of Coke).

I always figured I would reach this 20-year milestone. Diabetes hasn't been cured, but modern treatments, with accurate portable meters and genetically-engineered insulin, make it easier than ever for us diabetics to live relatively normal lives.

While I haven't been perfect at the task, I've done pretty well, and have avoided any complications for two decades. One twisted consequence of my terminal cancer is that now I won't face them at all, since any complications that did arise would be decades away. I won't live that long.

Without those modern treatments, I would have died early in 1991, and never gotten married, had kids, started a blog, or developed cancer. That's certainly something.

It was shockingly quiet here in the house all week, just me and Lucy the dog. I hardly went out, since I was pretty ill most of the time. My parents dropped by to check on me, walk the dog, and drop off food from time to time. But I spent the week—largely feeling content and by my own choice—mostly alone.

This afternoon my wife and two daughters returned from Victoria, where she had been attending a conference, pulling up in the car close to 3 p.m.

The transformation was instantaneous. Kids arguing, laundry flying, puppy barking, snacks inhaled, sudden clutter making magical appearances here and there. Air and I exchanged a few glances: she'd been dealing with this type of chaos by herself for six days and nights.

I had woken up mysteriously early this morning, and Air was tired after an early morning and the drive and ferry, so we crashed out for a nap while the kids played and watched TV. Despite the continued noise (even Lucy decided to chomp on a squeaky toy while lying between us), I had a smile on my face. It's better when the house is full.

I'm sure I'll tire of the hullabaloo soon enough, but not today.

When Dr. Anderson, the ear-nose-throat (ENT) specialist I saw today, grabbed his nasal endoscope (which I fondly thought of as his "nose cam") and took a look down my throat—an interesting experience for me, certainly—he was surprised. As a result, he's not treating my laryngitis yet. Let's find out why.

He asked me to try to hum, and I did, producing no sound at all, as expected. One of the vocal folds in my larynx wasn't vibrating, also as expected. When I try to talk, only one of my two vocal folds becomes "adducted" into position, and with no second fold to vibrate against, no sound happens. That's what laryngitis, or dysphonia, is all about:

But the slack vocal fold wasn't the one everyone was expecting. With all the information in my cancer patient file, describing all the tumours in my lungs and around my spine, Dr. Anderson—like my doctors at the B.C. Cancer Agency's Pain and Symptom Management Clinic last week—figured some of those tumours might be affecting a particular nerve. That is the recurrent laryngeal nerve (RLN), which connects my brain to the left vocal fold.

Not the wacky nerve, not acid, not bacteria

For historical-evolutionary reasons, in most vertebrates (including human) the left nerve loops from the brain, way down into the chest, and then back up to connect to the left side of the larynx—yes, even in whales and giraffes, where the nerve makes very long detours. In my body, there are lots of opportunities in my chest for interference from tumours, swelling, and so on.

But the right nerve takes a more direct route from the brain to the larynx, and there's no evidence of cancer or anything else interfering with the performance of that nerve. And, in my larynx, the right side is the slack side.

Dr. Anderson peered around with his nose cam (glurk), and saw no evidence of scarring from injury, or stomach acid from my occasional vomiting, or bacterial infection—which the antibiotic I took last week would have addressed anyway. He asked me if my throat was or had been sore (no), if I had any troubles with choking when I tried to swallow (no), or if I had any throat spasms (also no).

Staying voiceless to reduce the risk

So he wants me to wait yet longer, and see if my vocal cords will heal themselves. Had my left vocal fold been slack, he probably would have treated it right away, because the source would be much more likely to be nerve interference, and thus perhaps permanent. Spraying or injecting the slack fold would snap it into the "adducted" position where the functioning one could vibrate against it. (I think he might use Teflon, though he didn't say.)

UPDATE: No, Teflon is not a likely agent, it seems, since there are newer and better things to try. So, no jokes about my non-stick vocal cords, I guess.

Sounds great, but he recommended against doing that to the right fold, because if it's not paralyzed by nerve damage, and isn't infected with bacteria, and doesn't seem to be affected by acid reflux from my stomach, it is much more likely to be something temporary, such as a virus. After all, my laryngitis began after my whole family developed a viral infection one weekend back in February.

I still have a chest cough, and my immune system is weakened, of course. Viruses can linger in my system for a long time, and if they've knocked out my right vocal fold, that could take weeks to heal. (My mother, by comparison, has been recovering from shingles for six weeks, much as my wife had to do back in 2004.)

So spraying my right vocal fold to lock it into position might be a bad idea, because if it can heal on its own, then both sides of my vocal folds will adduct naturally, and vibrate against each other, as they should. If it's locked into position, then only one side, the left side, will vibrate. It will work—though I guess my voice might sound different. I got the impression that the spray might also potentially injure the fold it locks into position, since that essentially forces it from abducted (open) paralysis to adducted (closed) paralysis.

Fear and frustration

It didn't occur to me until just now, and Dr. Anderson said nothing about this idea, but if we did snap the right side into a permanently adducted position, and later the RLN became injured because of pressure from my chest tumours and paralyzed my left vocal fold, I'd lose my voice again. I'm not even sure what the consequences and implications of that are. It would suck, to say the least.

So while it's tremendously frustrating, it does seem reasonable to wait. I will see Dr. Anderson and his nose cam again in a few weeks. I hope when I do, it will be with a naturally-recovered voice. If not, I'll plan to go with the spray then, and hope that will bring back my speech. In the meantime, if I talk to you, expect what I now think of as "the usual whisper."

While the general trend of my health is—as anyone should expect—downward, it's hard to know when I'm having a down day or two, as opposed to entering a new phase of declining health more generally. This past weekend, while my pain was better than average, my fatigue kept me pretty much stuck in the house hanging out with the dog, throwing up occasionally. I started to wonder whether I was suddenly becoming housebound. Yesterday's post gave you a clue to my mindset.

Yet today I was quite a lot better, more awake, able to do more chores (cleaning out the fridge, a bit of laundry), just generally feeling in a better mood, mentally and physically. I still didn't get out, but at least I felt like I could.

And tomorrow I will. I have an appointment to see an Dr. Anderson, an ENT specialist in Coquitlam, in the afternoon about my laryngitis. If anyone can find a solution, I'm hoping Dr. Anderson will be the guy. To have some part of my body start working relatively normally again would be a boost to my disposition. At the least, it would be nice if people calling on the phone could expect to hear and understand me clearly.

What is the verdict following my full weekend (62 hours) of self-imposed speechlessness? No effect whatsoever: my laryngitis (or, to introduce another term, dysphonia) remains in full force, and a whisper is still about the best I can do. So among the doctors' referrals I'm waiting for, I'm hoping the otolaryngologist (ear, nose, and throat) specialist contacts me soon.

Tomorrow it will be a full month since I stopped being able to talk full voice, or sing, or be heard in any but the quietest environments. It's become pretty damn frustrating, especially for someone who's usually as talkative as I am. Nor did I find the task of not talking on Saturday and Sunday the least bit fun.

The weather isn't helping. I perked up slightly yesterday when the sun came out, but Vancouver has returned to grey spring drizzle today. My aunt and uncle had enough of it last week, and took one of their regular trips to the Nevada desert. I can understand their motivation.

I've now had laryngitis, preventing me from speaking in more than a whisper or a rasp, for 24 days. I saw my doctors at the B.C. Cancer Agency yesterday, and they are referring me to an ear-nose-throat (ENT) specialist as soon as possible. Despite a couple of minor encouraging signs this week, simple rest and fluids didn't work, and an antibiotic didn't work.

My friend Evie suggested early on that it could be result of, or exacerbated by, a type of acid reflux. That's among the most common causes of laryngitis, and treatment for reflux (which she didn't know she had) cleared hers up after four weeks. It could be something more exotic, however (pressure on the body's most famous nerve, the RLN?), with potentially more exotic treatments (spraying one side of my larynx with Teflon?).

Anyway, we'll see what the ENT specialist says. In the meantime, my wife and kids are away for a few days, so I'm going to take the chance tomorrow (Saturday) and the day after (Sunday) to rest my larynx by not speaking at all. No whispering, no rasping, no nothing. Most of you won't notice, since you only see what I type anyway.

But I won't answer the phone. Whoever leaves a message will have to have some other way—SMS, text chat, Facebook, Twitter, email—for me to communicate back. Anyone seeing me in person will get messages written out on pieces of paper (yes, that's faster than an iPad, shut up).

Oft-time loner that I am, I suspect I might enjoy it a bit.

P.S. Yesterday my wife tweeted that I have "vocal cord paralysis," which alarmed a few people. I'll note that "vocal cord paralysis" and "laryngitis" mean the same thing (as does "I've lost my voice"): my vocal cords won't vibrate to produce sound. They describe a symptom, but not what's causing it, or what could treat it. A different name need not mean things are worse, or better, or different at all.

Last night, at bedtime, I put the new Adele album 21 in my headphones and settled down to sleep. Within three songs, I was crying hot tears, my face scrunched up so I couldn't see. I couldn't stop. I didn't want to. I sobbed silently through nine more tracks and 40 minutes in the dark (weeping with laryngitis is one more weird experience), enough that I was worried I'd short out one of the earbuds.

Music, that most human of instincts and inventions, can do that at its very best: reach past our rational minds, through any analysis or cynicism, beyond any physical pain or discomfort, directly to our emotions. Then it can draw those feelings out and tap them to the surface, even (especially?) when we didn't know just what was in there. I've had it happen: listening to the astounding student choir in the auditorium at the high school where my wife works, hearing Stevie Ray Vaughan play "Little Wing" by Jimi Hendrix, a few transcendent moments onstage with my own band in front of crowds big or small.

But Adele's "furious tornado of a voice" (as Pitchfork's Tom Breihan called it) pierces me. She's half my age, British, and likes to hit the pub with her friends, but that voice and the conviction behind it are why she's also a number-one selling artist in countries around the world right now. She's the queen of heartbreak. Every time she comes on with little but piano as backing, like on "Turning Tables" or "Someone Like You," and "Hometown Glory" or Bob Dylan's "Make You Feel My Love" from her previous collection, 19, I completely lose it...

Hang on. Have to take a break here for a second...

Heartbreak

Sheesh. It's like I'm a mopey '80s teen wallowing in my room to Robert Smith and Morrissey (and, back then, I wasn't). The funny thing is, Adele has a Cure cover on the album ("Lovesong"), and while it's very good indeed, it doesn't have the desperate edge of the original. I don't know whether it's the riff, or the way Smith sang "I will always love you" in 1989, but he made it clear that the love wasn't coming back, and maybe never got there to start with.

Adele's own songs often do accomplish that, in spades. Let's take one. At the end of her staggering BRIT Awards version of "Someone Like You" (the live recording went straight to #1 on the British charts), the announcer says something like, "You don't need dancers and pyro and lasers, do you?" Basically he's telling all the other acts at the awards, from Rihanna to Arcade Fire, "This girl can kick your ass any day of the week." And he's right. I'm sure she knows it, but whenever I've seen her end a song, she appears like she has to shake it off a bit, then she looks off to the side slightly, as if thinking, "Was that me?"

But there's a more subtle part of the performance that's worth examining. Here are the lyrics for the chorus:

Never mind, I'll find someone like you,
I wish nothing but the best for you, too,
Don't forget me, I beg,
I remember you said,
Sometimes it lasts in love,
But sometimes it hurts instead.

At the BRIT Awards and at every other live performance I've heard of that song, Adele sings the first four lines in the same, strong, high part of her vocal range, then pulls it down a little for the last two. It works great.

The moment

But listen to the version on the album. I think it's slightly too fast, but here's what I guess happened: producer Dan Wilson asked Adele to try something different in the chorus, to sing the third line ("Don't forget me, I beg...") higher than her normal range, where it almost cracks. It's not an unusual technique for even great singers to try straining on purpose, maybe creating some of the finest moments in popular music. (Think of John Lennon on the Beatles' "Twist and Shout," Roger Daltrey on the Who's "Won't Get Fooled Again," or the entire careers of James Brown, Janis Joplin, and AC/DC.)

For Adele, that moment, right there, the one line—"Don't forget me, I beg"—is the focus of the song, the crux of the album, the very keen point of the ice pick when it first hits the diamond and shatters it, the moment of heartbreak.

And here's why it, and the rest of Adele's songs, made me cry like that last night. There's the heartbreak of rejection, of unrequited love. There's the heartbreak of breaking up, of losing love. There's the heartbreak of getting dumped, of not being loved anymore. They ache, they seethe, they're horrible. That's what Adele makes her business singing about.

But worst of all is the heartbreak of having been in love, for years, and both of you still being in love. But one of you is going to die. And no one, neither of you, not anyone else, can do anything about it.

That's not what Adele is singing about, not directly. I hope she never knows how it feels, or if she does, that it's many, many years away. I didn't invite her voice there, but it seems to know, so when it breaks down my barriers and taps the depths, that's where it goes, and what comes out.

Catching up on some Quirks and Quarks podcasts last night, I came across an amazing discovery about orcas (a.k.a. killer whales). Scroll down to "A Killer Diet" on this page to listen.

Here's the research paper and a summary from the Vancouver Aquarium. Essentially, a group of transient orcas near Unimak Island in the Aleutians hunt gray whales each spring, usually separating a juvenile gray whale from its mother, then killing and eating it.

For killer whales, that's not especially unusual: many of their populations around the world hunt other whales much larger than they are (even blue whales), using clever pack behaviour, often in the open ocean. But the problem is that most whale carcasses sink after they die, so the orcas can only get to some of the blubbery whale goodness before it disappears into the abyssal depths. (Interesting stuff can happen after that too, but we're on a different story.)

The Unimak orcas have taken advantage of gray whales' defensive behaviour, which is to retreat to shallow water. Separating the juvenile prey from its adult defenders in the relative shallows (10 to 20 m) has allowed the orcas to invent a refrigerator for themselves. Because even a juvenile grey whale provides too much meat for a pack of killer whales to eat all at once.

So the orcas eat, then let their prey sink. But the rocky bottom is right there, and a day or so later, they come back to dive down for leftovers. And again, and again, for nearly a week—like a human fridge after Thanksgiving. (It's Alaska just after winter, so the water is nice and cold too.) In the meantime, other sea creatures—including sharks, as well as invertebrates—chomp and grind away at the remains. Even local bears get in on the action, salvaging bits that float ashore.

This all shows why killer whales are among the most flexible, ingenious, and successful large predators in the world. While they're most common in temperate oceans near shore, orcas range throughout the world's marine surface ecosystems, from the Arctic to the Antarctic, from the Mediterranean to tropical seas. They are the top predator in all those places: nothing else eats them. In those different habitats, they often have specialized diets, hunted with customized techniques learned, and then passed from generation to generation.

We have the Unimak gray whale fridge. Resident populations near my home in British Columbia eat salmon; some people think the whales stun the fish by focusing their vocalizations through the melons at the fronts of their heads. Transient pods here eat marine mammals instead, mostly seals and sea lions, sometimes tossing them in the air during pursuit. But in one spot in South America, the killer whales ride the surf, emerging from the foam to snatch sea lions right off the beach. Off Norway, orcas trap schools of herring in rings of bubbles. Near San Francisco, scientists recorded orcas hunting a great white shark by flipping it on its back, which immobilized the fish and eventually killed it.

I suspect that no other type of carnivore has such a diversity of hunting behaviour. That's probably because they are mammals (the largest variety of dolphin) like us, with big brains—which they obviously use very effectively. Most predator species, whether on land or in the ocean, have common hunting behaviours, and often highly specialized bodies to accommodate them. But killer whales have evolved—as a species—to be generalists. They are smart, they can improvise, they can plan, and they learn. They teach each other what works and how to do it, and pass the knowledge down through families. You might even say they have culture.

This weekend is brought to you by "The Big C" and the word phlegm—a word whose spelling I've always enjoyed. I do not enjoy horking it up all day, however. Time for bed.

UPDATE March 13: The coughing and phlegm have almost entirely subsided. I am much less exhausted than I was yesterday, though I am still pretty tired. Most annoying, in all my hacking, I pulled muscles on both sides of my ribcage and in both shoulder blades. I feel like I was tossed into a CFL football game. I hope I didn't actually crack any bones.

There are a couple of encouraging notes, however. First, I've been able to sleep on my left side, which I've always preferred, but which I've been unable to do for weeks, because of mysterious pains which also seem to have dissipated. Second, a teeny, tiny part of my voice seems to be coming back, the first sign in almost three weeks that I might regain the ability to speak.

I won't make any bets: my body has been a mess these past few days, and who knows what it will do tonight or tomorrow, but at least there are a few good signs. Now we need some damn spring weather.

Right after the Indian Ocean earthquake and tsunami at the end of 2004, I wrote what turned into a long article about it, and about tsunamis more generally. People found the piece useful, so following today's devastating 8.9-magnitude quake and tsunamis in Japan, I thought I'd point it out again, particularly my general introduction and the Q&A section later on.

Today's situation is different, of course. Damaging tsunamis seem to have been largely restricted to the coastline of Japan itself; Hawaii and the rest of us around the Pacific Rim saw comparatively minimal effects (the wide-open coasts of southern Oregon and northern California seemed to get the worst of it), if any. And Japan has probably the world's most sophisticated earthquake and tsunami response system, as well as the most stringent seismic building codes. Many hundreds (perhaps thousands) of people died in Japan today, and there will be vast costs in rebuilding—but in 2004 the death toll around the Indian Ocean was over 230,000. Last year's Haiti quake, of far lower magnitude, killed hundreds of thousands too.

As a measure of how much modernization has changed things, as recently as 1923 over 100,000 died in the Kanto quake, which was not nearly as strong, but also generated tsunamis. Remember that when people (as they inevitably will) start talking about the relatively low death toll from today's events as "a miracle": it was only a miracle comprising knowledge, understanding of history and plate tectonics, planning, engineering, construction, communications, discipline, and other sorts of hard human work.

The low cost in lives and injuries does not, however, diminish the pain and suffering encompassed in each of those lives. It does not make it easier to witness one's house or office destroyed. It does not clean debris from a formerly vibrant seashore, or put out a raging fire, or comfort an orphan.

It does tell us one thing. We have another reason, among many, to diminish poverty in the world. Because when a natural disaster strikes—indifferent, in itself, to the wealth of its victims—those who are poor are least prepared to face it, and more likely to find themselves under the rubble than figuring out what to do once it's cleared away.

I found today one of mixed messages. Over the course of a few minutes' watching the news on TV this morning, I saw this:

• Today marks 100 years of International Women's Day, focusing on reducing inequality and oppression. Much has changed for the better in a century, but there remains a long way to go, especially outside the Western world. In Canada, there are several hundreds events underway.
  
  
• But today is also Mardis Gras in New Orleans, where men toss cheap bead necklaces to encourage women to show their breasts.
  
  
• And Starbucks Coffee celebrates its 40th anniversary today by unveiling what I think is a fairly spiffy new logo. Yet at the celebration event in Seattle, Starbucks CEO Howard Schultz was surrounded by a bunch of male executives dressed (like him) in suits, then a bunch of baristas (mostly female) in aprons.

Yes, some way to go.

I stopped chemotherapy and other treatments to fight my cancer back in November, but I certainly haven't stopped taking drugs. The latest addition isn't one I expected: Ritalin. No, cancer hasn't made me hyperactive. Quite the opposite, in fact. I'm often tired and listless, and when I caught a virus a couple of weeks ago, it not only gave me the persistent laryngitis I've been complaining about, it also knocked me so flat I could hardly get out of bed to eat or use the bathroom.

Knowing that, one of the doctors at the B.C. Cancer Agency's Pain and Symptom Management Clinic recommended the Ritalin, because one of its uses is treating excessive fatigue—as well as sleeping disorders such as narcolepsy. And it seems to work! If I take it with breakfast, I'm much less likely to need a long, long nap. One reason I made it through my living wake on Thursday was taking one mid-afternoon that day. And today, sluggish as all hell when my wife got home at dinnertime, I took one and perked up to be with the family all evening.

I can't take Ritalin daily, however. The doctor suggested I skip a day or two each week—"pyjama days," she called them—or I might develop a tolerance where I'd have to keep upping the dosage. Accordingly, I took none Saturday (which was fine, I even went out for dinner) or yesterday (which was a washout, sleepy and low-energy). It's nice to know that it's possible for me not to be a complete slug most of the time.

What other medications am I on? Oh, it's a long list: domperidone, to reduce reflux and vomiting; morphine, both long- and short-acting, to counteract back and torso pain from my tumours; Imodium, to try (usually unsuccessfully) to control bowel symptoms and diarrhea; Fragmin, an anticoagulant injection to avoid further blood clots; and Tylenol and other painkillers if I have a fever or further aches.

And of course there are long-acting Lantus and short-acting Humalog, two varieties of customized human insulin made by genetically engineered bacteria. As of this month, I've injected insulin multiple times a day for 20 years, since March 1991, when I first developed Type I (a.k.a. juvenile) diabetes. Without insulin, and the associated poking of my fingers to test my blood glucose levels multiple times daily, I'd have been dead back then, age 21, when my pancreas stopped making insulin of its own.

Without insulin injections, in other words, I would never have lived to get married, have kids, write a blog—or develop malignant colorectal tumours. I may only live half a "normal" lifespan because of my cancer, but for most of human history, without modern medicine, diabetes would have killed me before I even got half this far.

A dying man can wish for many things, but one of them might be to have a party with many family and friends: like a funeral, memorial, or wake, but actually being able to be there, before he dies. That's exactly what my wife Air put together for me a couple of nights ago, on March 3. We had a "living wake" at the newly-renovated Waldorf Hotel in East Vancouver, with a couple of hundred of the people in our lives joining us for a great Lebanese buffet, lots of mingling and chatting, and some fine live rock-n-roll music from my old bandmates and me, as well as my friends in Vancouver's legendary group Odds.

We couldn't throw the invitations wide open because fire regulations restricted how many people were allowed in the grand tiki-themed room in the Waldorf's basement—and we wanted to make sure that the people who came really were those I knew, and didn't get crowded out. After all, it was a wake, not just a party. Luckily, we didn't have very many uninvited door-crashers (and a few guests missed out because of flu and other illness), so we stayed within the limit, and it all worked out.

A dress-up crowd

Amazingly, in fact, few people I wished I could have invited if I'd had contact info, and others I never expected to make it, showed up anyway. Some I hadn't seen in many years, or came from very far away, so that was a nice bonus too. There were family members I've known my whole life, and friends I've had for 10, 20, even close to 30 years. I think I had a chance to say hi to almost everyone. My apologies to the few of you I missed.

Most of them had their pictures taken in the photo booth set up by the awesome Miranda and Reilly of Blue Olive Photography. There are other pictures appearing on Flickr, YouTube, and elsewhere (such as blog posts) with the tag penmachine, with more to come (if you have any from the event, please use that tag yourself). You can also tag pictures and videos with my name on Facebook. We had this slideshow projected on the wall all night too:

I was shocked at how well I survived the evening. I did plan carefully: I took the right combination of medications at the right times, napped in the afternoon, avoided eating too much during the day, and simply ran on endorphins until almost the very end of the evening. During dinner I went upstairs and ate in the hotel room we booked, lying on the bed, to recover some energy. Then, after far more stints on the drums than I thought I'd be able to tolerate, I finally burned out and announced to everyone that I needed to lie down, then disappeared to let them wind things down. I paid for it afterwards, and all the next day, but it was entirely worth it.

Speaking of that announcement, yes, I still had (and have) complete laryngitis. Through the PA system, I rasped out a very few words, sounding like Christian Bale's Batman in The Dark Knight. Out on the loudness of the floor, I was completely inaudible unless I whispered directly into people's ears. I sometimes resorted to typing stuff out on my iPhone for them to read. It was bizarre and frustrating, but somehow appropriate—it was like being a speechless ghost, drifting in the semi-background at my own wake. It also kept anyone from trying to monopolize my time, since I couldn't engage in any serious conversation.

The thank-you brigade

Others made up for it. My wife Air coordinated the evening (and avoided crying, somehow), the guys in the band cracked the usual jokes, and there were four extremely short and touching speeches from those close to me: my friends Tara, Dennis, and Johan, and my (pregnant!) cousin Tarya (MP3 files, between 1 and 4 minutes each). We had tremendous help from my parents Hilkka and Karl (he made the slideshow too), our friend Steven, current and former members of The Neurotics and other bands I've been in, Pat and Craig and Doug from the Odds, the staff at the Waldorf, and our kids Marina and Lolo, who couldn't come because of B.C.'s stupid liquor laws, but who kept themselves and another friend's daughter entertained at home until we got back late.

My biggest thanks, of course, go to Air. It was all her idea, and her work that made my living wake happen. She has kept our family going through my four-plus years of cancer, through surgeries and fear and chemotherapy and a prognosis of death. She made this party happen now, while I could enjoy it and join my friends and family, instead of after I die when I can't. We've been married more than 15 years, and I've said before: that is not nearly enough.

Thank you, too, to all of you guests who could come. I'll remember it my whole life. I hope the rest of you will remember it even longer.

All I can say is wow. And no, it's not Photoshopped:

The light in the water is bioluminescence.

It's March 1, and spring approaches. What was I thinking about in the previous 10 years on this date? Since my blog is now old enough, we can find out:

• 2001: I had just re-joined my old band.
• 2002: I highlighted some of the websites I worked on, and an online style guide I didn't.
• 2003: I waited a few days, then spewed out stuff about digital cameras, earplugs, software piracy, cheap pens, and the Editors' Association of Canada.
• 2004: I went on one of my regular rants about how human brains misunderstand statistics.
• 2005: I marked the death of Jef Raskin, irascible pioneer of computer interfaces.
• 2006: The bizarre and unlamented iPod Hi-Fi, women in science, and the Internet as oxygen.
• 2007: I learned a good lesson about painkillers.
• 2008: I almost passed out in a messy and embarrassing way.
• 2009: A fantastic drive to Tofino on Vancouver Island.
• 2010: The fun-yet-schockingly-lame 2010 Olympic Closing Ceremony.

It's unlikely I'll live until March 1 next year, so that list should now be complete.