From the end of 1996 to September 1997, we were privileged to experience the courage of Paul Klem through his beautiful and generous wife Laurie, who shared her humor, advocacy, intelligence, strength and fortitude all along the way. With her permission, we are posting her own chronology of Paul's fight with Non-Hodgkin's Lymphoma, Stage IV, high grade. We deeply appreciate the intimate look at a family coping with NHL, and we hope this helps catalyze even more efforts toward vanquishing this despicable disease.

5/96 Goes to regular MD because of a persistent cough. Doc prescribes antibiotics. Paul attributes cough to 20+years smoking.
7/96 Goes to regular MD because of persistent & intense itching. Doc says it's athletes foot gone up the leg & spread by scratching Prescribes many different creams that do nothing. Itching continues all summer & into fall.
7-9/96 Persistent & soaking night sweats. Wife attributes sweating to the very hot humid conditions of Buffalo in the summer. Wonders why the bed is so very wet every morning though.
10/28/96 Wakes up with very swollen legs & feet. Cannot put sneakers on. Calls & makes appointment with regular doc who immediately does chest xray. One lung is black - one lung is white. He is immediately admitted to the first hospital. They do the xray and ct scan. He is then scheduled to be moved. Meanwhile wife is in Las vegas on a business trip - is told by Paul - don't worry, it's nothing. All the while, Paul is listed as critical.
11/6/96 Diagnosis of Non Hodgkins lymphoma
11/96 Paul begins 6 sessions of CHOP
12/96 Paul & Laurie join the NHL list. Laurie prints out all the mail for Paul to read on a daily basis - thereby earning Paul the title of "Lurker once removed"
3/97 Chop is over & ct scans reveal not much change. In fact some areas are growing. Onc plans on a Bone Marrow Transplant down the road, but would like to try high dose chemo first.
4/15 Search for bone marrow donor commences. Paul's brother, father & children are all ruled out - no match. Only searching the National registry at this point.
4/20/97 Paul admitted for what could be 4-6 weeks but turns out to be 18 days. Receives VP-16 & Cytoxan. Tolerates that well - Last day of stay (5/2/97) stem cell harvest is done - just in case. All done in one 3 hour sitting. Nurses remark that he had some very HEALTHY cells.
7/97 Paul admitted again for auto bmt or baby bmt as he calls it. No radiation is used. Onc holds off on radiation because of the possibility of an allo bmt down the road and "you can only have so much radiation in a lifetime" [yeah, tell that to the folks at Chernobyl] Paul receives Melphalan as the chemo. Tolerates this well again. Only stays in the hospital for 5 days when the possible stay was again 4-6 weeks. [can you tell he HATES Roswell!!]
7/97 Search for match on marrow goes to International & cord blood registries [WHY DIDN'T THEY DO THIS IN THE BEGINNING??]
7/10/97 Laurie's birthday. Paul receives his own stem cells. He smells funny but is ok. WANTS TO GO HOME to recover -badgers the doctors and they finally release him.
8/97 Two weeks after bmt - Paul begins to feel excessively tired. Onc says that's normal. ct scans & gallium done on 7/29 reveal little if no change in condition of mass in lung. on feely exam - lymph nodes are becoming much more noticeable. [arm pit & around collarbone]
8/97 Onc decides to try Taxol as a stall technique until bmt match can be found. Paul has two treatments. not much different feeling. Still very tired. We tell onc that we are going on vacation - he decides a bit of radiation to relieve the breathing might be in order. Paul has 2 5 minute treatment on the bronchial area [upper chest] Nothing remarkable about that except the radiology group is the NICEST group we've met at Roswell.
9/97 Paul's admitted to Roswell and they discover he has internal bleeding. He doesn't eat much & has great difficulty breathing. An endoscopy is done to look for ulcer in stomach. Find one 1/2 dollar size. Doctor gives two possible scenarios.....do nothing, make him comfortable for ??? 2 weeks???? or do surgery on the ulcer & radiation on upper chest. Anesthesiologist say he cannot tolerate surgery because of the breathing problems - he's on one lung at the moment. More ctscan, muga, pulmonary function tests all reveal the cancer is rampant & out of control. [IT'S BEEN THIS WAY ALL ALONG GUYS!!]
9/4/97 Paul has first upper body radiation. No difference yet. Heart rate is high [120-130] catheter is put in for draining. He's given heparin to break up any possible clots. Arm is swollen due to lymph nodes blocking fluid drainage. Is on very slow drip fluids & pepcid for ulcer.
9/5/97 Taken off IV - he will have to take fluids on his own. Has second radiation treatment. No real difference. Very tired & short of breath. Doc says that if in the next few weeks he "feels better" from the radiation he can go to hospice or home or stay in hospital whatever Paul prefers. Paul says he wants to go home. Laurie is not sure if she's ready to have him die at home. DNR order is signed, will, power of attorney & living will is signed & witnessed.
9/6/97 Third radiation treatment is today at 8:30. Paul called at 7:30 to say hi. Nothing's changed - still feels the same. Tired, short of breath & hating every minute of it.
In the end - it's Non Hodgkins lymphoma, Stage IV, high grade, large/intermediate cell, diffuse, b symptoms and best of all Severe Primary Refractory Disease.
September 11, 1997 Died at Roswell Park Memorial Cancer Center, Buffalo, New York.
Love, Laurie Klem

Paul and Chris