Inauguraton Day

If you are reading these posts in sequence it would appear that I blogged twice on Inauguration Day. Actually, I attempted to post the previous entry on Friday, but was thwarted by the internet system at UCSF, which failed to provide me with a network IP address. Happily this problem has clearly been addressed by the IT staff, and my link again works perfectly, allowing me to continue in the incredibly important task of documenting our dining out experiences while enduring 30 radiation treatments. And this post, mostly composed on Inauguration Day, has floated around in the ether for more than a week until I found the time to finish it.

Once again, we've had our lovely sequence of lunches interrupted by reality, this time in the form of the extreme amount of work it has taken to get our house ready to show to the public. Yes, we've arguably chosen the worst time in the last decade to put our house on the market; on the other hand, we're not desperate to sell, and if we're not happy with offers we will move to Plan B, whatever that might be. So a sandwich and a glass of beer at home is about all I could manage today, while Andrea used the toaster oven to heat up mini Chicken Tacos from Trader Joe's. Not quite in the same league as some of the lunches we've enjoyed. Not even close.

Meanwhile, on the treatment end the finish line is in sight. The facility was closed yesterday for MLK Day, but Andrea received two treatments on Friday and is going for two more this Friday. Also, today is the last of the 'proton' treatments; the remaining five appointments are for 'electron' radiation. These descriptions of the radiation were provided by the supervising doctor during the preliminary visit, but when Andrea mentioned them to the technicians they described the two forms of treatment differently, describing the second form of treatment as 'clinical.' There's a big difference in the routine. With the 'proton' treatment it is critical that the body is positioned to maximize the targeted area while minimizing the exposure of the rest of the body. This requires not only mini tattoos on the body, but also a bit of shoving around on the table to achieve the precise effect. During the treatment the machine moves around you and pulses, then relocates itself to a second position and pulses again. .The 'electron' treatment is administered through a customized sort of waveguide that fits on the machine. The machine remains stationary, and makes no noise at all. Of course all these details apply to Andrea's specific treatment, since every individual receives a customized protocol.

 The appointments have to be separated by at least six hours when you do two in a day. The way we handled it was to go in for an 8AM zap; then we drove back to San Rafael, where I went to my exercise class. From there we returned home and proceeded to work on the house, and finally back to the city for a 4:15PM session. Then we hung around since our daughter Sophie had agreed to meet us for dinner. We went to Calzone's, an Italian cafe on Columbus Avenue in San Francisco's legendary North Beach, right up the street from City Lights bookstore, an icon since the Beat era. After that we checked into Tommaso's, a restaurant right off Broadway on Kearney Street that has been around for decades. We were seated at the 'reserved at all times for the family' table, which got things off to a nice start. Tommaso's has just a few booths and some tables in the center of the room. The last time we visited, perhaps 20 years ago, it was quite dark, but has been repainted in a lighter style. The room includes a small counter, behind which is the centerpiece of their cooking, the wood-fired oven. A steady flow of pizzas passed in and out of the opening, manned by a pizzaiola who by all appearances had many years of experience. We opted for all sorts of dishes, too many dishes. These included deep fried calamari, ravioli and meatballs, eggplant (wood oven roasted in Parmigiana style,)and a spinach salad with Parmesan and nuts. To this we added a liter of house red, which they graciously allowed us to taste before commiting. This was about two dishes too many for three people, since servings are generous and hearty. The pizza we ordered was quite simple, with just pepperoni and cheese, since there is a generational difference in acceptable ingredients when it comes to pizza (we favor eggplant and mushrooms, which are no-no's on pizza to Sophie.) This came out as your basic house-made pizza, with an inbetween crust that was neither thin nor thick, and a light topping of tomato sauce with plenty of cheese. While not dramatic or mind-blowing, it was quite delicious. The hit of the evening had to be the ravioli, which are definitely house-made and masterful. The two large meatballs somehow managed to be delicate and light without containing excessive breading, which is quite a trick to pull off. Our friend Brooke says it is probably like the technique for arrivng at light matzo balls: don't over-compress them or handle them too much before baking. I would hazard a guess that they also use more bread crumbs than I might be inclined to add, but I have to say I enjoyed their rendition. Tommaso's tomato sauce is chunky and elemental, with just tomatoes, some olive oil, a hint of herbs and not a heck of a lot more. To pull this off requires the use of high-quality tomatoes, and it would not surprise me to find large cans of San Marzano tomatoes imported from Italy in the storehouse. The spinach salad was relentlessly fresh, and again, only the highest-quality ingredients found their way into the dish. Calamari, served first, was obviously fried in the cleanest of oil, and was exactly the right texture; the moment you over-cook calamari it turns to rubber. In my experience it only comes out right in Italian and Thai restaurants, and Tommaso's has it down. They use larger pieces than most places, so there is a higher ratio of 'insides' to breading, making it more of a meal than an appetizer, all the more reason why there were leftovers.

Prices are quite moderate, especially given the generous serving sizes and the quality of ingredients. Tommaso's shines because they don't attempt to do too many things; they cook simply but tastefully and their specialties are done professionally. It is old school at its finest; vintage recipes and cooking techniques executed with a high degree of care.

The Sunny Mediteranée

The blogging project has been subject to some drift lately. On a couple of occasions we ran out of time, and I resorted to my old standby, the Cheesesteak Shoppe. I am happy to report that this return visit, one of many I have made over the years, did nothing to lessen my high opinion of their Philly cheesesteak. We also were blindsided by the fact that many Asian restaurants have chosen Tuesday as their day off, a fact that we could have easily researched in advance but simply neglected to do. One day when we left the house late we stopped in at a new taqueria in San Rafael (Marin County.) This was a perfectly good experience, and I made the age-old mistake of eating something larger than my head, or at least so it seemed as I downed a chicken molé super burrito. While fully appreciative of the generous amounts of chicken provided therein, the taqueria was merely competent, like so many others, and the recipes and salsas completely predictable. So why go further? Just another taqueria among many, and like most, they don't hand-press their corn tortillas, which immediately marks them as simply ordinary.

Yesterday things took a turn for the better; we decided to try La Mediteranée, a cafe located just south of Pacific Heights in the chic part of Fillmore Street. This neighborhood, and Fillmore Street in particular, has steadily climbed upward and now sports elegant boutiques as well as a host of restaurants. Many of the city's popular restaurants are flocking to this area, opening new outposts. Notable are Dosa (second location) and Pizzeria Delfina (second location, plus they run a full restaurant next door to their Mission District pizza shop.) SPQR is another notable, and it is the second restaurant from a group that also runs A16 in the Marina area on the north side of San Francisco.

La Mediteranée, in contrast, has been on Fillmore for a while. It is a small cafe with a few compact outside tables that specializes in what looks for all the world to be Lebanese food, plus some daily fresh fish specials. We were seated outside immediately; Andrea settled on a falafel sandwich, while I was planning to opt for the Lebanese Plate, which offered a choice of three items from a fairly extensive list of Lebanese specialities like Pomegranate Chicken, dolmades, hummus and many more. As we were ordering the diners next to us received their meal. Andrea asked what one of their dishes was, and it turned out to be a Chicken Shwarma sandwich. It looked so good that I ordered it instead of the variety plate.

As we waited for food it was hard to believe it was the middle of winter. The Bay Area had record-shattering warmth that day, beating the old maximums by quite a bit, so we basked in 70-degree air, and I sat on the sunny side of the table and absorbed a decent dose of sunlight, which hopefully sufficed to boost my vitamin D. The latest research has elevated the importance of this vitamin as a factor in maintaining good health; it seems to affect calcium absorption, which can in turn affect bone density. It also seems to be a factor in the prevention of cancer. So even though my skin tends to burn very quickly, I have become more tolerant of the sun (Andrea and I call it 'Mean Mister Sun',) albeit only for short periods, and the time afforded for lunch at the cafe was just right.

The food exceeded expectations. Both sandwiches were served in a rolled-up lavosh bread, the same sort of wrap used in Levantine Sandwiches. This had been made crisp, probably with a brief stay under a salamander broiler, and had a pleasant crunch to it as you bit through. The fillings offered all the usual flavors of Lebanese dishes, but were exceptionally balanced so each spice and condiment shone through; a hint of mint here, a dash of cinnamon there. Although the portion on the plate did not appear enormous, it proved to be quite filling, and the sides were equally caloric regardless of the diminutive serving size. One of the tastiest was a potato salad, with the potatoes chopped finely, blended with some parsley and lightly pickled in a vinaigrette. There was even a neatly arranged bit of fruit, which washed down the rich flavors nicely at the end. All in all, a delicious outing and an unexpected pleasure as we basked in the mid-winter, very summer-like weather.

Heck of a Way to Get a Tan

I am nothing if not sensitive to feedback from my followers, all 9 of you if you exclude me (the Sharps) and Andrea. And one comment that has returned from the field is that while the food part of the blog is entertaining, we have not heard all that much about radiation.

The good news in this regard is that the treatment, in Andrea's case, has been routine. This is nothing to complain about, and hardly minimizes the entire process of sitting through 30 sessions of being zapped. But this is not a story about dramatic experiences; rather, the process is almost eerily calm and ordered. This is not the case for all recipients of radiation treatment, which is something you discover when you share a changing room with patients destined for the four different machines at this particular facility at University of California, San Francisco.

Thanks to my daughter Rosie, I have become a reader of Wired magazine. Although they sometimes make me ill with their over-printed, over-inked, overly-glossy and glitzy style, I have to admit that there are some damn good writers covering some topics that don't see much light of day in other publications. The most recent issue had an article about cancer that in essence says the spending pyramid is inverted - - that is, 90 percent of money is spent on patients with Stage 3 or Stage 4 cancers, which are the two most advanced states. This is not surprising; as they point out, these are husbands, wives, mothers, fathers, sons and daughters - - loved ones, in deep peril. So no expense is spared. The point they bring forth is that if the spending was on early detection there would be few cases that progress to this difficult and expensive-to-deal-with degree.

Andrea is a prime example of the advantages of early detection. Thanks to the routine program at Kaiser Northern California, her relatively minuscule tumor was caught early, perhaps not has early as is technologically possible, but pretty close. So dealing with this tumor via lumpectomy, radiation and prescription drug therapy (Arimidex) is pretty cut and dried (ouch!) The therapy is not perfect; perhaps three to five percent of patients who undergo this protocol will have a recurrence in five years. Ninety-five percent or more will not. They will simply be cured by surgery, 30 treatments and five years of pill popping, one a day.

That does not mean that the treatment is inconsequential, and that it is not without its unique effects on the patient. For one thing, there are the nice gowns. You need to change into a gown before treatment, and you only undress and cover with a gown the section of you that needs treatment. Breast people get a bathrobe-style top that opens in the front. These are very soft, since they've been washed and sanitized many times, and provide a degree of comfort that offsets the coldness and starkness of lying on a highly adjustable metal table that can accommodate the myriad positions required to direct the radiation to the desired spot. Another strange source of comfort is the large circle in the ceiling of the treatment area. When the lights are off, it looks more or less like conventional acoustical tile. But when back-lit, someone has taken the trouble to put patterns of celestial constellations into it. It reminds Andrea of visiting the Planetarium in the Museum of Natural History as a child. The upper part of the machine rotates around you to pinpoint its action; in Andrea's case it then pivots to the other side and repeats the treatment. Radiation treatment is not a single therapy; different types (wavelengths) are used for various purposes. Five weeks of her treatment is with proton radiation. This is a penetrating emission, which is one reason all the positioning is so critical. You don't want to shoot it into parts of the body that don't need it, so it is directed more or less horizontally across the treatment area, from the side. At the end of the five weeks she will receive one week of electron radiation. This is directed right at the treatment area, but does not penetrate deeply at all.

The type of radiation you receive, the length of treatment and any concurrent therapies vary completely from patient to patient and by type of cancer. Each treatment, no matter how routine on the surface, is in fact custom-designed to the situation and physical being of each individual. Among those sharing the changing room one day was a woman needing radiation for the eye; obviously this is a whole different protocol than the breast, or than a prostate gland.

As you look up to the glass surface of the radiation source, childish stickers have been plastered around the metal surrounding the central glass cover. While these might be thought of as lame they provide a humanizing and slightly comic contrast to the sterile and frightening presence of this device looming over you.

Returning again to our patient, we are ever vigilant in looking out for symptoms of and reactions to treatment. Most commonly reported are sunburn of a sort, and fatigue, which build up as the weeks go by and sessions accumulate. So far, so good. Maybe a little redness on the skin, which is alleviated at least somewhat by the lotions provided by the facility. Still, it's a heck of a way to get a tan. This could very well get worse, but we are told that it goes away fairly promptly after the end of treatment. As for fatigue, it has not taken an undue toll so far, and in fact Andrea's energy has been notably high. On occasion Andrea has had some random sharp twinges in the treatment area. This too they say is routine, and is not at all constant.

So we have our fingers crossed and will hope for the best. If you don't see that much more about radiation treatment and instead quite a bit more about dining out, you'll know that all is well.