Dear Marion,

Thank you for your letter. Congenital pessimist that I am, its contents
didn't surprise me, because my experience suggested to me that a
seventy year old woman with faintness and giddiness, with an elevated
white count, afebrile, with minimal cough and a pulmonary infiltrate
is ill with something other than pneumonia. That was the logic behind
my recent insistent queries about your well-being.

I'm much appreciative for your forwarding Dr. Skarda's letter to me, but
I don't take it as an invitation or a license to insinuate my thoughts
and feelings into your most personal affairs. Obviously you require time
to orient yourself to the perplexities and problems that suddenly,
unexpectedly present themselves to you. When you are ready, tell me
in what way, if any, you would like me involved. 


By now you should know me well enough, mindful especially of my concerns
for Margrit, that I am prepared to involve myself, - better said, to take
your problems to heart - to any degree congenial to you. I haven't 
forwarded your correspondence from Dr. Skarda to Klemens, - and I won't
until you give me permission. Would you like me to? Klemens, as you know
is sensitive, knowledgeable and intelligent about medical matters, and
working at the center of a large medical institution has many colleagues
whose opinions and advice are available to him. I would readily discuss
your problems with Klemens, if you wished, but there's also no reason,
if you wished, why you shouldn't write to Klemens directly. 
kmeyer@tuftsmedicalcenter.org

There is also my brother-in-law, Margaret's youngest brother, Peter
McPhedran, peter.mcphedran@yale.edu, now 74 years old, a very experienced
hematologist/oncologist who has directed the Yale University Medical
School hematology laboratory for many years. I would be pleased, if 
you wished, to "present your case" to Peter for his opinion and advice.
You should also feel free to introduce yourself directly to Peter, e-mail
him the clinical data and send him a blood smear. Peter and I have for
many years been on very good terms. I like him very much and I have no
reservations about quizzing him to my mind's content. I should add,
however, that he and I think differently, and sometimes come to
diametrically opposite conclusions about medical matters. I am always
grateful for his advice and try to learn from him. I don't argue with
him but in the end, I keep my own counsel.

As I understand it, the threshold issue for you is the extent, if any
to which you wish to manage your medical problems yourself. You have
the intellectual and emotional resources, not to speak of the scientific
training, to function as your own physician. You can't perform surgical
operations on yourself, but you can certainly make for yourself _all_
the decisions which are conventially delegated to a hematologist. It
would surprise me if already at this incipient stage of the disease
there weren't numerous diagnostic, therapeutic, prophylactic options,
the simplest being: how often should the blood count be repeated?

You can procrastinate and postpone doing anything until such time,
if ever, that the disease incapacitates you.

You can take the conventional approach and delegate all responsibility
to Dr. Skarda and the consultants to whom she will send you.

The only thing you can't do is to stop writing to me.
I hope to hear from you soon.

Jochen